Healthcare Provider Details

I. General information

NPI: 1871559286
Provider Name (Legal Business Name): U OF L RESEARCH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 CENTRAL AVE 200
LOUISVILLE KY
40208
US

IV. Provider business mailing address

501 E BROADWAY STE 120
LOUISVILLE KY
40202
US

V. Phone/Fax

Practice location:
  • Phone: 502-637-9313
  • Fax: 502-635-6317
Mailing address:
  • Phone: 502-562-6810
  • Fax: 502-562-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES OBRIEN
Title or Position: CHAIRMAN OF DEPT
Credential: MD
Phone: 502-852-5498