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General NPI Number Information
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NPI Number | 1255467239
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Entity Type | Organization
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Legal Business Name | UNIVERSITY PEDIATRICS INFECTIOUS DISEASES, LLC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 12/07/2009
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Provider Practice Location Address
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Address Line | 210 E GRAY ST SUITE 802
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City | LOUISVILLE
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State | KY
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Zip | 40202-3904
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Country | US
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Telephone | 502-852-8632
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Fax | 502-852-3939
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Provider Business Mailing Address
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Address Line | PO BOX 2469
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City | LOUISVILLE
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State | KY
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Zip | 40201-2469
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Country | US
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Telephone | 502-852-8500
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Fax | 502-852-8556
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GERARD P RABALAIS
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Credential | M.D.
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Telephone | 502-852-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number |
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License Number State |
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