Healthcare Provider Details

I. General information

NPI: 1093195869
Provider Name (Legal Business Name): HEART TO HEART PEDIATRIC CARDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 SPRINGHURST BLVD STE 104
LOUISVILLE KY
40241-6137
US

IV. Provider business mailing address

1111 BALMORAL DR
LOUISVILLE KY
40205-3331
US

V. Phone/Fax

Practice location:
  • Phone: 502-425-5614
  • Fax: 502-425-5633
Mailing address:
  • Phone: 502-425-5614
  • Fax: 502-425-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA R. KLEIN
Title or Position: OWNER
Credential: MD
Phone: 502-425-5614