Healthcare Provider Details

I. General information

NPI: 1508669672
Provider Name (Legal Business Name): MASON FOUNDATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LIBERTY ST
LOUISVILLE KY
40202-1434
US

IV. Provider business mailing address

4141 W MUHAMMAD ALI BLVD
LOUISVILLE KY
40212-2437
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-2500
  • Fax:
Mailing address:
  • Phone: 502-299-2362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: DR. RODNEY E KOSFELD
Title or Position: HEMATOLOGIST
Credential: MD
Phone: 502-629-2500