Healthcare Provider Details

I. General information

NPI: 1689101552
Provider Name (Legal Business Name): MEGAN BUTTLEMAN CORIELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 S FLOYD ST STE 412
LOUISVILLE KY
40202-3877
US

IV. Provider business mailing address

571 S FLOYD ST STE 412
LOUISVILLE KY
40202-3877
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-8828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number009047
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number53801
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number53801
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: