Basic Information
| Provider Information | |||||||||
| NPI: | 1700347341 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SADLE | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | JAKE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | OFFICE OF MEDICAL EDUCATION C/O BRITTNEY LUCKETT | ||||||||
| Address2: | 571 S. FLOYD ST., STE. 412 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026298828 | ||||||||
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| Practice Location | |||||||||
| Address1: | OFFICE OF MEDICAL EDUCATION C/O BRITTNEY LUCKETT | ||||||||
| Address2: | 571 S. FLOYD ST., STE. 412 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038033110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2019 | ||||||||
| LastUpdateDate: | 03/27/2019 | ||||||||
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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 | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.