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General NPI Number Information
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NPI Number | 1932236148
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Entity Type | Organization
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Legal Business Name | MEDICAL LABORATORY CONSULTANTS, PLLC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 221 S PRESTON ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-1223
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Country | US
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Telephone | 502-589-1980
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Fax | 502-589-1982
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Provider Business Mailing Address
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Address Line | 221 S PRESTON ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-1223
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Country | US
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Telephone | 502-589-1980
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Fax | 502-589-1982
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. STEWART E WOLFSON
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Credential | MD
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Telephone | 502-589-1980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 200241
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License Number State | KY
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