Basic Information
| Provider Information | |||||||||
| NPI: | 1285821876 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PLATO | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | MAXWELL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 950202 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402950202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022725100 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 3991 DUTCHMANS LN STE 200 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028996782 | ||||||||
| FaxNumber: | 5028996783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2007 | ||||||||
| LastUpdateDate: | 03/01/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | IP1053 | KY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 03254 | KY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 000000713238 | 01 | KY | ANTHEM- NNS | OTHER | 125846 | 01 | KY | SIHO- NNS | OTHER | P00948778 | 01 | KY | RAILROAD MEDICARE | OTHER | 201024570 | 05 | IN | MEDICAID | 7100133150 | 05 | KY | MEDICAID | 000057120E | 01 | KY | HUMANA- NNS | OTHER | 50033166 | 01 | KY | PASSPORT- NNS | OTHER |