Healthcare Provider Details

I. General information

NPI: 1568893915
Provider Name (Legal Business Name): UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S FLOYD ST
LOUISVILLE KY
40202-3822
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-8990
  • Fax:
Mailing address:
  • Phone: 502-588-0320
  • Fax: 502-588-0326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAVID DUNN
Title or Position: EVP OF HEALTH AFFAIRS
Credential: MD
Phone: 502-852-5184