Healthcare Provider Details

I. General information

NPI: 1578505137
Provider Name (Legal Business Name): ENDOCRINE & DIABETES ASSOCIATES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LIBERTY ST SUITE 400
LOUISVILLE KY
40202-1434
US

IV. Provider business mailing address

100 E LIBERTY ST SUITE 400
LOUISVILLE KY
40202-1434
US

V. Phone/Fax

Practice location:
  • Phone: 502-587-6010
  • Fax: 502-587-1314
Mailing address:
  • Phone: 502-587-6010
  • Fax: 502-587-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID E BYBEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 502-587-6010