Individual ProviderKenneth FomuluInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address200 E Chestnut St Bldg Suite303, Louisville, KY 40202-1831(502) 629-5552(502) 588-9490PECOS EnrollmentBased on the most recent information from CMS, provider Kenneth Fomulu is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1700376373Provider TypeIndividualFull NameFomulu, KennethTitleDr.CredentialMDGenderMaleSole ProprietorNoEnumeration Date5/18/2018Last Updated8/2/2024Contact InformationPractice LocationPractice Address200 E Chestnut St Bldg Suite303, Louisville, KY 40202-1831Phone(502) 629-5552Fax(502) 629-3132Mailing LocationMailing AddressPO Box 776351, Chicago, IL 60677-6351Phone(502) 588-9490Fax(502) 272-5116Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense56277KentuckyCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer