=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407982085
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIDGET BERG HITTEPOLE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 03/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 E CHESTNUT ST SUITE 370
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40202-2040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-813-6800
-----------------------------------------------------
Fax | 502-562-6515
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 E BROADWAY STE 290
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40202-2040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-217-8221
-----------------------------------------------------
Fax | 502-217-5056
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 42853
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------