MEDICARE: DR. ERICA LAFAYE GETTIS D. O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0116027328	VA
2	207R00000X	Internal Medicine Physician	04121	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053727602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICA LAFAYE GETTIS D. O.

Provider Business Mailing Address
First Line	:	100 E LIBERTY ST STE 800
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1428
Country	:	US
Telephone Number	:	502-210-4530
Fax Number	:	502-210-4531

Provider Business Practice Location Address
First Line	:	2401 TERRA CROSSING BLVD STE 402
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-5371
Country	:	US
Telephone Number	:	502-210-4530
Fax Number	:	502-210-4531

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2014
Last Update Date	:	03/12/2018

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