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General NPI Number Information
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NPI Number | 1699954008
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC & SPORTS SPECIALISTS OF LOUISVILLE, PSC
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 9370 CEDAR CENTER WAY
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City | LOUISVILLE
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State | KY
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Zip | 40291
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Country | US
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Telephone | 502-762-9528
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Fax |
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Provider Business Mailing Address
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Address Line | 9370 CEDAR CENTER WAY
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City | LOUISVILLE
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State | KY
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Zip | 40291
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Country | US
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Telephone | 502-762-9528
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | ANDREW L. DEGRUCCIO
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Credential | M.D.
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Telephone | 502-762-9528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 29694
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License Number State | KY
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