Provider Demographics
NPI:1003214396
Name:HAND AND WRIST OF LOUISVILLE, PLLC
Entity Type:Organization
Organization Name:HAND AND WRIST OF LOUISVILLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-409-6898
Mailing Address - Street 1:2400 EASTPOINT PKWY
Mailing Address - Street 2:STE 570
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4154
Mailing Address - Country:US
Mailing Address - Phone:502-409-6898
Mailing Address - Fax:855-852-7155
Practice Address - Street 1:2400 EASTPOINT PKWY
Practice Address - Street 2:STE 570
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4154
Practice Address - Country:US
Practice Address - Phone:502-409-6898
Practice Address - Fax:855-852-7155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY472772082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK146710Medicare PIN