MEDICARE: ADRIAN J PELLEGRINI M.D.

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	2084P0800X	Psychiatry Physician	25430	KY
2	2084P0800X	Psychiatry Physician	V6511	TX

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	:	1063415099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIAN J PELLEGRINI M.D.

Provider Business Mailing Address
First Line	:	4121 SHELBYVILLE RD STE 3
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-3205
Country	:	US
Telephone Number	:	502-899-9980
Fax Number	:	502-899-9981

Provider Business Practice Location Address
First Line	:	4003 KRESGE WAY
Second Line	:	STE 224
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4652
Country	:	US
Telephone Number	:	502-899-9980
Fax Number	:	502-899-9981

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/05/2026

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