MEDICARE: PHLEBOLOGY ASSOCIATES OF LOUISVILLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	202K00000X	Phlebology Physician

General Provider Information

NPI Number	:	1790905818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHLEBOLOGY ASSOCIATES OF LOUISVILLE

Provider Business Mailing Address
First Line	:	112 SOUTH SHERRIN AVENUE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-3222
Country	:	US
Telephone Number	:	502-895-6600
Fax Number	:	502-899-1229

Provider Business Practice Location Address
First Line	:	112 SOUTH SHERRIN AVENUE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-3222
Country	:	US
Telephone Number	:	502-895-6600
Fax Number	:	502-899-1229

Authorized Official
Title or Position	:	PHYSICIAN - PRACTICE MANAGER
Name	:	DR. LEESA V RICHARDSON
Credential	:	MD
Telephone Number	:	502-895-6600

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	08/22/2020

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