=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053535278
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES F FRANCKE III M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8135 NEW LAGRANGE RD
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40222-4682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-423-1997
-----------------------------------------------------
Fax | 502-423-1935
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8901 LYNDON LAKES PL
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40242-4537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-426-3458
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 23384
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------