Healthcare Provider Details

I. General information

NPI: 1497751044
Provider Name (Legal Business Name): LISA RACHELLE KLEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA RACHELLE KIRSCH MD

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E CHESTNUT ST
LOUISVILLE KY
40202-1713
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-7450
  • Fax: 502-589-1256
Mailing address:
  • Phone: 502-588-7450
  • Fax: 502-589-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number29111
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: