Healthcare Provider Details

I. General information

NPI: 1184049264
Provider Name (Legal Business Name): KARTZINEL WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 MAGISTERIAL DR
LOUISVILLE KY
40223-5184
US

IV. Provider business mailing address

14 REDGATE CT
SILVER SPRING MD
20905-5726
US

V. Phone/Fax

Practice location:
  • Phone: 240-454-1649
  • Fax: 402-590-2627
Mailing address:
  • Phone: 240-454-1649
  • Fax: 402-590-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number46645
License Number StateKY

VIII. Authorized Official

Name: MISS KAREN DENISE WEBB
Title or Position: CREDENTIALING ADMINISTRATOR
Credential:
Phone: 240-454-1649