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General NPI Number Information
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NPI Number | 1184760357
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Entity Type | Organization
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Legal Business Name | LOUISVILLE NEUROSURGICAL SPECIALIST PSC
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/20/2007
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Provider Practice Location Address
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Address Line | 4010 DUPONT CIR SUITE L28
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City | LOUISVILLE
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State | KY
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Zip | 40207-4812
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Country | US
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Telephone | 502-899-9099
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Fax | 502-899-9899
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Provider Business Mailing Address
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Address Line | 4010 DUPONT CIR SUITE L28
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City | LOUISVILLE
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State | KY
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Zip | 40207-4812
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Country | US
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Telephone | 502-899-9099
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Fax | 502-899-9899
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | DAVID PETRUSKA
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Credential | MD
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Telephone | 502-899-9099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 24702
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License Number State | KY
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