MEDICARE: DR. BRUCE J TASCH 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	22305	KY

General Provider Information

NPI Number	:	1396726675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE J TASCH M.D.

Provider Business Mailing Address
First Line	:	6000 BROWNSBORO PARK BLVD
Second Line	:	SUITE G
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-7201
Country	:	US
Telephone Number	:	502-899-9560
Fax Number	:	502-899-9561

Provider Business Practice Location Address
First Line	:	6000 BROWNSBORO PARK BLVD
Second Line	:	SUITE G
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-7201
Country	:	US
Telephone Number	:	502-899-9560
Fax Number	:	502-899-9561

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	03/10/2014

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