Healthcare Provider Details

I. General information

NPI: 1578568739
Provider Name (Legal Business Name): LOUIS R KIRTLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 DUTCHMANS LN STE 400
LOUISVILLE KY
40207-4711
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-0697
  • Fax: 502-897-0658
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number20700
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: