Healthcare Provider Details

I. General information

NPI: 1538738000
Provider Name (Legal Business Name): LOUISVILLE OCCUPATIONAL AND GENERAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4814 PRESTON HWY
LOUISVILLE KY
40213-2235
US

IV. Provider business mailing address

4814 PRESTON HWY
LOUISVILLE KY
40213-2235
US

V. Phone/Fax

Practice location:
  • Phone: 502-890-5037
  • Fax: 502-384-2104
Mailing address:
  • Phone: 502-890-5037
  • Fax: 502-384-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILSON L. ESEME JR.
Title or Position: OWNER
Credential: MD
Phone: 502-890-5037