Healthcare Provider Details

I. General information

NPI: 1902937584
Provider Name (Legal Business Name): SARAH GREER MIZUGUCHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH ELIZABETH GREER M.D.

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 DUPONT CIR STE 230
LOUISVILLE KY
40207
US

IV. Provider business mailing address

2700 STANLEY GAULT PKWY STE 129
LOUISVILLE KY
40223-5176
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-1333
  • Fax: 502-899-9576
Mailing address:
  • Phone: 502-253-4900
  • Fax: 502-489-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberR0495
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: