Provider Demographics
NPI:1225038177
Name:SECOR, CHAD PHILIP (MD)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:PHILIP
Last Name:SECOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4003 KRESGE WAY
Mailing Address - Street 2:STE 227
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4652
Mailing Address - Country:US
Mailing Address - Phone:502-893-3342
Mailing Address - Fax:502-893-3342
Practice Address - Street 1:4003 KRESGE WAY
Practice Address - Street 2:STE 227
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4652
Practice Address - Country:US
Practice Address - Phone:502-893-3342
Practice Address - Fax:502-893-9575
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY35860207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64085376Medicaid
7864717OtherCIGNA
50005766OtherPASSPORT HEALTHCARE
0000000329395OtherANTHEM BCBS
10-00015OtherUNITED HEALTHCARE
P00145931OtherRR MEDICARE
I02580Medicare UPIN
1324704Medicare ID - Type Unspecified