Healthcare Provider Details

I. General information

NPI: 1619084431
Provider Name (Legal Business Name): LISA M VUOCOLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

IV. Provider business mailing address

228 S HITE AVE
LOUISVILLE KY
40206-2517
US

V. Phone/Fax

Practice location:
  • Phone: 502-287-5995
  • Fax:
Mailing address:
  • Phone: 502-894-2897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30469
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number30469
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: