Healthcare Provider Details

I. General information

NPI: 1679218077
Provider Name (Legal Business Name): UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 DUTCHMANS LANE
LOU KY
40207
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-259-6610
  • Fax:
Mailing address:
  • Phone: 502-588-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TONI GANZEL
Title or Position: VP OF HEALTH AFFAIRS
Credential: MD
Phone: 502-852-5555