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NPI Code Detail

MEDICARE: ALLEN DEAN HACK MD

MEDICARE: ALLEN DEAN HACK 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
1207R00000XInternal Medicine Physician25887KY
2208000000XPediatrics Physician25887KY
3208M00000XHospitalist PhysicianMD171953OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000633080OTHERKYANTHEM
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750346482
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLEN DEAN HACK MD
Provider Business Mailing Address
First Line : 6801 DIXIE HWY
Second Line : SUITE 130
City : LOUISVILLE
State : KY
Zip : 40258-3913
Country : US
Telephone Number : 502-367-3360
Fax Number : 502-367-3365
Provider Business Practice Location Address
First Line : 1850 BLUEGRASS AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40215-1161
Country : US
Telephone Number : 502-367-3360
Fax Number : 502-367-3365
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2006
Last Update Date : 04/29/2016

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Directions to “ ALLEN DEAN HACK MD” Practice Location

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