Basic Information
| Provider Information | |||||||||
| NPI: | 1629014675 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AVANESOV | ||||||||
| FirstName: | KAREN | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 E GRAY ST | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025847525 | ||||||||
| FaxNumber: | 5025846851 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 E GRAY ST | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025847525 | ||||||||
| FaxNumber: | 5025846851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 07/06/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | 238138 | NY | N | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | 207XS0117X | 03167 | KY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207XS0117X | 238138 | NY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207X00000X | 238138 | NY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3740627000 | 01 | KY | PASSPORT ADVANTAGE- NORTON LEATHERMAN SPINE CENTER | OTHER | 7100084130 | 05 | KY | MEDICAID | 50025970 | 01 | KY | PASSPORT- NORTON LEATHERMAN SPINE CENTER | OTHER | 200952070 | 01 | KY | SIHO- NORTON LEATHERMAN SPINE CENTER | OTHER | 000000628579 | 01 | KY | ANTHEM- NORTON LEATHERMAN SPINE CENTER | OTHER | 000051983P | 01 | KY | HUMANA- NORTON LEATHERMAN SPINE CENTER | OTHER | 00533170 | 01 | KY | ADVANTRA FREEDOM- NORTON LEATHERMAN SPINE CENTER | OTHER | 200952070 | 01 | KY | HEALTHY INDIANA PLAN- NORTON LEATHERMAN SPINE CENTER | OTHER | 200952070 | 05 | IN | MEDICAID |