Healthcare Provider Details

I. General information

NPI: 1356845838
Provider Name (Legal Business Name): ANTHONY LEONARD GRZEDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 06/10/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4003 KRESGE WAY STE 300
LOUISVILLE KY
40207-4652
US

IV. Provider business mailing address

1901 CAMPUS PL
LOUISVILLE KY
40299-2308
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-5139
  • Fax: 502-896-6218
Mailing address:
  • Phone: 502-253-5924
  • Fax: 502-489-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2023-00238
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number01096409A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: