Healthcare Provider Details

I. General information

NPI: 1033436282
Provider Name (Legal Business Name): UNIVERSITY PEDIATRICS FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 SHELBYVILLE RD
LOUISVILLE KY
40223-2977
US

IV. Provider business mailing address

PO BOX 2469
LOUISVILLE KY
40201-2469
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-3320
  • Fax: 502-629-3975
Mailing address:
  • Phone: 502-852-8500
  • Fax: 502-852-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GERARD P. RABALAIS
Title or Position: CHAIRMAN
Credential: MD
Phone: 502-852-8600