Basic Information
| Provider Information | |||||||||
| NPI: | 1730274929 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TZANETOS | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | BAZIL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9800 SHELBYVILLE RD STE 220 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402232992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024298585 | ||||||||
| FaxNumber: | 5024296157 | ||||||||
| Practice Location | |||||||||
| Address1: | 9113 LEESGATE RD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402225003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024261621 | ||||||||
| FaxNumber: | 5024267906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 12/13/2018 | ||||||||
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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 | 207K00000X | 39285 | KY | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
No ID Information.