Basic Information
| Provider Information | |||||||||
| NPI: | 1427099373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BISCETTE | ||||||||
| FirstName: | SHAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 909 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402010909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025880329 | ||||||||
| FaxNumber: | 5025880326 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 E CHESTNUT ST | ||||||||
| Address2: | SUITE # 410 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402025700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022715999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 11/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | L7668 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 43587 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000000669382 | 01 | KY | ANTHEM PSC | OTHER | 50029461 | 01 | KY | PASSPORT & ADVANTAGE FOUNDATION PCP# | OTHER | 7100126470 | 05 | KY | MEDICAID | 50029462 | 01 | KY | PASSPORT & ADVANTAGE FOUNDATION SPECIALIST # | OTHER | 7945517 | 01 | KY | AETNA | OTHER | 000000669272 | 01 | KY | ANTHEM FOUNDATION # | OTHER | 200989200 | 05 | IN | MEDICAID | 50039463 | 01 | KY | PASSPORT & ADVANTAGE PSC SPECIALIST # | OTHER |