MEDICARE: ELIZABETH ROUSE WONG 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
1	207Q00000X	Family Medicine Physician	27435	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00386070	OTHER	KY	RAILROAD MEDICARE KY/NORT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	076693	OTHER	KY	SIHO/NORTON
4	000000479493	OTHER		ANTHEM - NCMA
5	283734000	OTHER	KY	PASSPORT ADVANTAGE/NORTON
6	50014617	OTHER	KY	PASSPORT/NORTON

General Provider Information

NPI Number	:	1891799847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ROUSE WONG MD

Provider Business Mailing Address
First Line	:	100 E LIBERTY ST
Second Line	:	SUITE 800
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1434
Country	:	US
Telephone Number	:	502-968-6226
Fax Number	:	502-966-5567

Provider Business Practice Location Address
First Line	:	5100 OUTER LOOP
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40219-4056
Country	:	US
Telephone Number	:	502-968-6226
Fax Number	:	502-966-5567

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	03/21/2018

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