=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619063641
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOUISVILLE UROLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 03/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 BLUEGRASS AVE SUITE 203
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-375-0009
-----------------------------------------------------
Fax | 502-375-2150
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1900 BLUEGRASS AVE SUITE 203
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-375-0009
-----------------------------------------------------
Fax | 502-375-2150
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR PARTNER
-----------------------------------------------------
Name | ERIC R UHLENHUTH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 502-375-0009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------