Provider Demographics
NPI:1205830098
Name:JUHL, GREGORY LEE (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LEE
Last Name:JUHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:1000 DUPONT RD
Practice Address - Street 2:SUITE A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4611
Practice Address - Country:US
Practice Address - Phone:502-899-6150
Practice Address - Fax:502-891-6368
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24058208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100359650Medicaid
KY64240583Medicaid
IN100359650Medicaid
KY64240583Medicaid
KY023203Medicare PIN