Healthcare Provider Details

I. General information

NPI: 1326177890
Provider Name (Legal Business Name): RONALD PODOLL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 NEWBURG RD 106
LOUISVILLE KY
40218-2497
US

IV. Provider business mailing address

14308 MCKIRKLAND CT
LOUISVILLE KY
40245-4712
US

V. Phone/Fax

Practice location:
  • Phone: 502-451-1100
  • Fax: 502-451-1181
Mailing address:
  • Phone: 502-314-9028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number16803
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: