Healthcare Provider Details

I. General information

NPI: 1104816446
Provider Name (Legal Business Name): RAUL NAKAMATSU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ABRAHAM FLEXNER WAY
LOUISVILLE KY
40202-3841
US

IV. Provider business mailing address

501 E BROADWAY
LOUISVILLE KY
40202-2043
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5131
  • Fax: 502-589-5093
Mailing address:
  • Phone: 502-589-4856
  • Fax: 502-589-5093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number36573
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: