Healthcare Provider Details

I. General information

NPI: 1497743041
Provider Name (Legal Business Name): UROGYNECOLOGY SPECIALISTS OF KENTUCKIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 DUTCHMANS LN STE 515
LOUISVILLE KY
40207-4707
US

IV. Provider business mailing address

4121 DUTCHMANS LN STE 515
LOUISVILLE KY
40207-4707
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-2392
  • Fax: 502-897-2311
Mailing address:
  • Phone: 502-897-2392
  • Fax: 502-897-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROL A GRAHAM
Title or Position: PRESIDENT
Credential: MD
Phone: 502-897-2392