Healthcare Provider Details

I. General information

NPI: 1770104564
Provider Name (Legal Business Name): ABIGAIL RUTH GELLERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2020
Last Update Date: 07/15/2023
Certification Date: 07/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 S FLOYD ST
LOUISVILLE KY
40202-3818
US

IV. Provider business mailing address

571 S FLOYD ST
LOUISVILLE KY
40202-3818
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: