MEDICARE: MARK O GLADSTEIN MD PLLC

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	363L00000X	Nurse Practitioner
2	207X00000X	Orthopaedic Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20041432	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710102629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK O GLADSTEIN MD PLLC

Provider Business Mailing Address
First Line	:	250 E LIBERTY ST
Second Line	:	SUITE 1005
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1538
Country	:	US
Telephone Number	:	502-589-4448
Fax Number	:	502-589-1209

Provider Business Practice Location Address
First Line	:	250 E LIBERTY ST
Second Line	:	SUITE 1005
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1538
Country	:	US
Telephone Number	:	502-589-4448
Fax Number	:	502-589-1209

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MARK O GLADSTEIN
Credential	:	M.D.
Telephone Number	:	502-589-4448

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	12/23/2009

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Directions to “MARK O GLADSTEIN MD PLLC ” Practice Location

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