Healthcare Provider Details

I. General information

NPI: 1851533046
Provider Name (Legal Business Name): ELIZABETH ELLEN HARLAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ABRAHAM FLEXNER WAY
LOUISVILLE KY
40202-2877
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-587-4011
  • Fax: 502-587-4156
Mailing address:
  • Phone: 502-588-0325
  • Fax: 502-588-0326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number47932
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberMD60998085
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number47932
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: