MEDICARE: MRS. ELIZABETH U MAESER M.D.

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	208000000X	Pediatrics Physician	24095	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K117900	OTHER	KY	MEDICARE PTAN -NCMA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831283076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH U MAESER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 950202
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40295-0202
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:	502-272-5116

Provider Business Practice Location Address
First Line	:	10210 WESTPORT RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-2148
Country	:	US
Telephone Number	:	502-339-0444
Fax Number	:	502-339-1717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	02/16/2015

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