Basic Information
| Provider Information | |||||||||
| NPI: | 1679615637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAYROUZ | ||||||||
| FirstName: | ILANA | ||||||||
| MiddleName: | COHEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 94670 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731434670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056823303 | ||||||||
| FaxNumber: | 4053846793 | ||||||||
| Practice Location | |||||||||
| Address1: | 7101 W. HWY 22 | ||||||||
| Address2: | |||||||||
| City: | CRESTWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400148819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022416567 | ||||||||
| FaxNumber: | 5022415083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 11/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | R1459 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | R1459 | KY | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 43644 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.