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General NPI Number Information
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NPI Number | 1780697037
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Entity Type | Individual
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Provider Name | GROVER MARK TUSSEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 107 DIAGNOSTIC DR
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City | FRANKFORT
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State | KY
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Zip | 40601-6524
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Country | US
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Telephone | 502-875-9885
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Fax | 502-875-9882
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Provider Business Mailing Address
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Address Line | PO BOX 1820
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City | FRANKFORT
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State | KY
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Zip | 40602-1820
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Country | US
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Telephone | 502-226-3858
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Fax | 502-223-9829
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 37602
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License Number State | KY
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