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NPI Code Detail

MEDICARE: LOUISVILLE COLORECTAL ASSOCIATES LLC

MEDICARE: LOUISVILLE COLORECTAL ASSOCIATES LLC
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
1208C00000XColon & Rectal Surgery Physician16857KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21048817OTHERKYPASSPORT
32432234000OTHERKYPASSPORT ADVANTAGE

General Provider Information

NPI Number : 1649366196
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOUISVILLE COLORECTAL ASSOCIATES LLC
Provider Business Mailing Address
First Line : 250 E LIBERTY ST
Second Line : SUITE 610
City : LOUISVILLE
State : KY
Zip : 40202-1536
Country : US
Telephone Number : 502-584-6666
Fax Number : 502-589-6342
Provider Business Practice Location Address
First Line : 250 EAST LIBERTY STREET
Second Line : SUITE 610
City : LOUISVILLE
State : KY
Zip : 40202-1536
Country : US
Telephone Number : 502-584-6666
Fax Number : 502-589-6342
Authorized Official
Title or Position : PRESIDENT
Name : DR. LOWELL DEAN KATZ
Credential : MD
Telephone Number : 502-584-6666
Provider Enumeration Date : 10/04/2006
Last Update Date : 04/20/2008

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Directions to “LOUISVILLE COLORECTAL ASSOCIATES LLC ” Practice Location

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