Provider Demographics
NPI:1811975683
Name:ABADILLA, JUNE ELIZABETH
Entity type:Individual
Prefix:
First Name:JUNE
Middle Name:ELIZABETH
Last Name:ABADILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 JACKSON HTS
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-6500
Mailing Address - Country:US
Mailing Address - Phone:606-693-0199
Mailing Address - Fax:606-666-9480
Practice Address - Street 1:12 JACKSON HTS
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339
Practice Address - Country:US
Practice Address - Phone:606-666-7040
Practice Address - Fax:606-666-9480
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2022-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64087588Medicaid
KY0794403Medicare PIN
KYI02627Medicare UPIN