Healthcare Provider Details

I. General information

NPI: 1629083399
Provider Name (Legal Business Name): ASSOCIATES IN DERMATOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 SPRINGHURST BLVD SUITE 200
LOUISVILLE KY
40241
US

IV. Provider business mailing address

3810 SPRINGHURST BLVD SUITE 200
LOUISVILLE KY
40241-6100
US

V. Phone/Fax

Practice location:
  • Phone: 502-583-1749
  • Fax: 502-329-8184
Mailing address:
  • Phone: 502-583-1749
  • Fax: 502-329-8184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JYOTI BURRUSS
Title or Position: PARTNER
Credential: MD
Phone: 502-583-1749