Healthcare Provider Details

I. General information

NPI: 1356508329
Provider Name (Legal Business Name): ST LUKE TRISTATE WEIGHTLOSS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7380 TURFWAY RD
FLORENCE KY
41042-1355
US

IV. Provider business mailing address

7380 TURFWAY RD
FLORENCE KY
41042-1355
US

V. Phone/Fax

Practice location:
  • Phone: 859-212-4625
  • Fax: 859-212-4638
Mailing address:
  • Phone: 859-212-4625
  • Fax: 859-212-4638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS SONNANSTINE
Title or Position: PHYSICIAN
Credential: MD
Phone: 859-212-4625