Basic Information
| Provider Information | |||||||||
| NPI: | 1457333502 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALLUS | ||||||||
| FirstName: | COREY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 CHAMBER CENTER DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LAKESIDE PARK | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410171673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593445555 | ||||||||
| FaxNumber: | 8593017216 | ||||||||
| Practice Location | |||||||||
| Address1: | 1808 BRISTOW DRIVE | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410913513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593017210 | ||||||||
| FaxNumber: | 8593017216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 02553 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64012750 | 05 | KY | MEDICAID | 2387608 | 05 | OH | MEDICAID |