Healthcare Provider Details

I. General information

NPI: 1891789996
Provider Name (Legal Business Name): LAWRENCE J RUEFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 KRESGE WAY STE 315
LOUISVILLE KY
40207-4640
US

IV. Provider business mailing address

4001 KRESGE WAY STE 315
LOUISVILLE KY
40207-4640
US

V. Phone/Fax

Practice location:
  • Phone: 502-384-8520
  • Fax: 502-895-6638
Mailing address:
  • Phone: 502-384-8520
  • Fax: 502-895-6638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26028
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: