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General NPI Number Information
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NPI Number | 1679077531
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Entity Type | Individual
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Provider Name | TRAVIS PARKULO MD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 4130 DUTCHMANS LN STE 300
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City | LOUISVILLE
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State | KY
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Zip | 40207-4710
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Country | US
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Telephone | 502-897-1794
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Fax | 502-897-3852
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Provider Business Mailing Address
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Address Line | 4130 DUTCHMANS LN STE 300
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City | LOUISVILLE
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State | KY
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Zip | 40207-4710
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Country | US
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Telephone | 502-897-1794
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Fax | 502-897-3852
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | 59704
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 59704
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 59704
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License Number State | KY
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