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General NPI Number Information
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NPI Number | 1437531837
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Entity Type | Organization
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Legal Business Name | SUSAN B TATE MD PSC
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Dates
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Enumeration Date | 06/22/2015
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 2934 BRECKENRIDGE LN STE 2
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City | LOUISVILLE
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State | KY
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Zip | 40220-3903
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Country | US
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Telephone | 502-454-7871
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Fax | 502-454-7872
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Provider Business Mailing Address
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Address Line | 2934 BRECKENRIDGE LN STE 2
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City | LOUISVILLE
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State | KY
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Zip | 40220-3903
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Country | US
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Telephone | 502-454-7871
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Fax | 502-454-7872
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN TATE
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Credential | MD
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Telephone | 502-454-7871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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