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General NPI Number Information
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NPI Number | 1659699916
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Entity Type | Organization
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Legal Business Name | UROGYNECOLOGY CONSULTANTS PLLC
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 11/04/2010
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Provider Practice Location Address
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Address Line | 4121 DUTCHMANS LN STE 307
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City | LOUISVILLE
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State | KY
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Zip | 40207-4707
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Country | US
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Telephone | 502-409-5600
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Fax | 502-409-5606
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Provider Business Mailing Address
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Address Line | PO BOX 950136
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City | LOUISVILLE
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State | KY
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Zip | 40295-0136
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Country | US
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Telephone | 502-429-8505
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Fax | 502-429-8547
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CAROL A GRAHAM
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Credential | M.D.
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Telephone | 502-409-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 36345
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 36345
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License Number State | KY
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