Individual ProviderEphraim OtienoInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address550 S Jackson St Fl Street3, Louisville, KY 40202-1622(502) 852-5666(859) 625-2485PECOS EnrollmentBased on the most recent information from CMS, provider Ephraim Otieno does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1447994868Provider TypeIndividualFull NameOtieno, EphraimTitleDr.CredentialMDGenderMaleSole ProprietorYesEnumeration Date4/21/2022Last Updated4/30/2025Contact InformationPractice LocationPractice Address550 S Jackson St Fl Street3, Louisville, KY 40202-1622Phone(502) 852-5666FaxUnlisted FaxMailing LocationMailing Address609 E Main St Apt 253, Louisville, KY 40202-1451Phone(859) 625-2485FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense0000000KentuckyCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer