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General NPI Number Information
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NPI Number | 1750564530
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Entity Type | Organization
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Legal Business Name | PHYSICIANS SKIN CARE PLLC
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Dates
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Enumeration Date | 12/14/2007
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 1169 EASTERN PARKWAY SUITE #2310
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City | LOUISVILLE
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State | KY
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Zip | 40217
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Country | US
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Telephone | 502-451-9000
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Fax | 502-456-2728
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Provider Business Mailing Address
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Address Line | 1169 EASTERN PARKWAY SUIT #2310
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City | LOUISVILLE
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State | KY
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Zip | 40217
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Country | US
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Telephone | 502-451-9000
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Fax | 502-456-2728
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Authorized Official
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Title or Position | OWNER SOLE PROPRIETOR
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Name | DR. LEON KIRCIK
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Credential | MD
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Telephone | 502-451-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State | KY
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