Healthcare Provider Details

I. General information

NPI: 1255384004
Provider Name (Legal Business Name): SEBASTIAN PAGNI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 KRESGE WAY SUITE 46
LOUISVILLE KY
40207-4660
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 502-899-3858
  • Fax: 502-899-3878
Mailing address:
  • Phone: 502-489-5730
  • Fax: 502-489-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number32584
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: