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General NPI Number Information
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NPI Number | 1295852317
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Entity Type | Organization
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Legal Business Name | LOUISVILLE ENDOCRINOLOGY PSC
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3288 ILLINOIS AVE SUITE 100
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City | LOUISVILLE
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State | KY
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Zip | 40213
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Country | US
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Telephone | 502-515-6621
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Fax | 502-515-6620
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Provider Business Mailing Address
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Address Line | 3288 ILLINOIS AVE SUITE 101
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City | LOUISVILLE
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State | KY
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Zip | 40213
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Country | US
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Telephone | 502-515-6621
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Fax | 502-515-6620
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Authorized Official
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Title or Position | PHYSICIAN PRESIDENT
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Name | DR. DEBORAH ANN BALLARD
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Credential | MD
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Telephone | 502-515-6621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | KY26476
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License Number State | KY
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