Healthcare Provider Details

I. General information

NPI: 1518971571
Provider Name (Legal Business Name): MEDIFEM HEALTH, P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E LIBERTY ST 310
LOUISVILLE KY
40202-1530
US

IV. Provider business mailing address

250 E LIBERTY ST 310
LOUISVILLE KY
40202-1530
US

V. Phone/Fax

Practice location:
  • Phone: 502-587-6041
  • Fax: 502-589-0643
Mailing address:
  • Phone: 502-587-6041
  • Fax: 502-589-0643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2457P
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25111
License Number StateKY

VIII. Authorized Official

Name: DR. JEFFREY D GLAZER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 502-587-6041