Provider Demographics
NPI:1255657771
Name:LOUSVILLE UROGYNECOLOGY PLLC
Entity Type:Organization
Organization Name:LOUSVILLE UROGYNECOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:HEIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:502-895-0557
Mailing Address - Street 1:PO BOX 950188
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0188
Mailing Address - Country:US
Mailing Address - Phone:502-895-0557
Mailing Address - Fax:502-895-0579
Practice Address - Street 1:4121 DUTCHMANS LN
Practice Address - Street 2:SUITE 401
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4707
Practice Address - Country:US
Practice Address - Phone:502-895-0557
Practice Address - Fax:502-895-0579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30391207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100116270Medicaid
KYP100015901Medicare PIN
KY7100116270Medicaid