Healthcare Provider Details

I. General information

NPI: 1265630958
Provider Name (Legal Business Name): THEODORE BEN SWIRAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TED SWIRAT M.D.

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 BUECHEL BANK RD AP3-170 APPLIANCE PARK
LOUISVILLE KY
40225-0001
US

IV. Provider business mailing address

4000 BUECHEL BANK RD AP3-170 APPLIANCE PARK
LOUISVILLE KY
40225-0001
US

V. Phone/Fax

Practice location:
  • Phone: 502-452-0333
  • Fax: 502-452-0454
Mailing address:
  • Phone: 502-452-0333
  • Fax: 502-452-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29446
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: