Healthcare Provider Details

I. General information

NPI: 1003871799
Provider Name (Legal Business Name): TERRENCE P DONOHUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 POPLAR LEVEL RD STE 101
LOUISVILLE KY
40213-1076
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-636-7444
  • Fax: 502-636-7112
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22280
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: