Healthcare Provider Details

I. General information

NPI: 1770887572
Provider Name (Legal Business Name): LOUIS STERLING HEUSER SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 10/11/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 MELLWOOD AVE STE 197
LOUISVILLE KY
40206-1033
US

IV. Provider business mailing address

1860 MELLWOOD AVE STE 197
LOUISVILLE KY
40206-1033
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-7833
  • Fax: 502-895-4418
Mailing address:
  • Phone: 502-893-7833
  • Fax: 502-895-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number20389
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: