Provider Demographics
NPI:1366626558
Name:CELESTRE, PAUL C (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:CELESTRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:210 E GRAY ST STE 900
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3905
Practice Address - Country:US
Practice Address - Phone:502-584-7525
Practice Address - Fax:502-584-6851
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101253491207X00000X
LAMD207469207XS0117X
390200000X
KY45221207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08820221Medicaid
KYK058720OtherMEDICARE -NORTON LEATHERMAN SPINE
IN201109840Medicaid
LA2380893Medicaid
KY7100209390Medicaid
LA2380893Medicaid