Healthcare Provider Details

I. General information

NPI: 1790905818
Provider Name (Legal Business Name): PHLEBOLOGY ASSOCIATES OF LOUISVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 SOUTH SHERRIN AVENUE
LOUISVILLE KY
40207-3222
US

IV. Provider business mailing address

112 SOUTH SHERRIN AVENUE
LOUISVILLE KY
40207-3222
US

V. Phone/Fax

Practice location:
  • Phone: 502-895-6600
  • Fax: 502-899-1229
Mailing address:
  • Phone: 502-895-6600
  • Fax: 502-899-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEESA V RICHARDSON
Title or Position: PHYSICIAN - PRACTICE MANAGER
Credential: MD
Phone: 502-895-6600