Healthcare Provider Details

I. General information

NPI: 1114458205
Provider Name (Legal Business Name): PATRICK LAWRENCE HEGDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S JACKSON ST ROOM C1H17
LOUISVILLE KY
40202-1675
US

IV. Provider business mailing address

530 S JACKSON ST ROOM C1H17
LOUISVILLE KY
40202-1675
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5689
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberS5923
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number53014
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: