Healthcare Provider Details

I. General information

NPI: 1568504637
Provider Name (Legal Business Name): HEATHER MARIE TLUCZEK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER MARIE NEWCOMER D.O.

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 DUPONT CIR
LOUISVILLE KY
40207-4801
US

IV. Provider business mailing address

425 LEWIS HARGETT CIR
LEXINGTON KY
40503-3590
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-7401
  • Fax:
Mailing address:
  • Phone: 859-268-1030
  • Fax: 859-269-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number03074
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2003261A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number02003261A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: