Basic Information
| Provider Information | |||||||||
| NPI: | 1972873529 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF LOUISVILLE PHYSICIANS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ULP GENERAL SURGERY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 E BROADWAY STE 290 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402022040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022175134 | ||||||||
| FaxNumber: | 5022175056 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 E CHESTNUT ST UNIT 710 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402025707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025838303 | ||||||||
| FaxNumber: | 5025832938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2012 | ||||||||
| LastUpdateDate: | 01/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | ELLIOTT | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP OF HUMAN RESOURCES | ||||||||
| AuthorizedOfficialTelephone: | 5025612404 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.