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General NPI Number Information
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NPI Number | 1386070019
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Entity Type | Organization
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Legal Business Name | SUSAN RAGHAVAN, MD
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | 9720 PARK PLAZA AVE UNIT 202
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City | LOUISVILLE
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State | KY
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Zip | 40241-2290
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Country | US
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Telephone | 502-327-9703
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Fax | 502-327-9798
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Provider Business Mailing Address
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Address Line | 9720 PARK PLAZA AVE UNIT 202
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City | LOUISVILLE
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State | KY
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Zip | 40241-2290
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Country | US
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Telephone | 502-327-9703
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Fax | 502-327-9798
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Authorized Official
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Title or Position | BILLING DEPT
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Name | SUSIE MINSTERKETTER
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Credential |
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Telephone | 502-327-9703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | 34555
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License Number State | KY
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