Healthcare Provider Details

I. General information

NPI: 1114919834
Provider Name (Legal Business Name): BRIAN JOSEPH PARADOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ABRAHAM FLEXNER WAY SUITE 304
LOUISVILLE KY
40202-1846
US

IV. Provider business mailing address

100 E LIBERTY ST STE 800
LOUISVILLE KY
40202-1428
US

V. Phone/Fax

Practice location:
  • Phone: 502-585-1200
  • Fax: 502-585-1207
Mailing address:
  • Phone: 502-585-1200
  • Fax: 502-585-1207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number32796
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: