Healthcare Provider Details

I. General information

NPI: 1477582112
Provider Name (Legal Business Name): YVETTE MARIE CUA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S JACKSON ST
LOUISVILLE KY
40202-1622
US

IV. Provider business mailing address

550 S JACKSON ST
LOUISVILLE KY
40202-1622
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-1595
  • Fax: 502-852-8980
Mailing address:
  • Phone: 502-852-1595
  • Fax: 502-852-8980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number44031
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: