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NPI Code Detail

MEDICARE: ALLEN GREGORY DEAM MD

MEDICARE: ALLEN GREGORY DEAM MD
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
1207RC0001XClinical Cardiac Electrophysiology Physician30384KY
2207RC0000XCardiovascular Disease Physician30384KY

Other Identifiers

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

General Provider Information

NPI Number : 1285634683
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLEN GREGORY DEAM MD
Provider Business Mailing Address
First Line : 2700 STANLEY GAULT PKWY STE 129
Second Line :
City : LOUISVILLE
State : KY
Zip : 40223-5176
Country : US
Telephone Number : 502-489-6613
Fax Number : 502-489-5751
Provider Business Practice Location Address
First Line : 3950 KRESGE WAY STE 303
Second Line :
City : LOUISVILLE
State : KY
Zip : 40207-4637
Country : US
Telephone Number : 502-928-0900
Fax Number : 502-928-0901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 12/03/2020

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