Healthcare Provider Details

I. General information

NPI: 1326262742
Provider Name (Legal Business Name): KOSAIR HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 E CHESTNUT ST
LOUISVILLE KY
40202-1821
US

IV. Provider business mailing address

6692 NORTHRIDGE CIR
LOUISVILLE KY
40241-6540
US

V. Phone/Fax

Practice location:
  • Phone: 502-420-6758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. EVANGELIA GRAVARI
Title or Position: RESIDENT
Credential:
Phone: 502-629-8828