Provider Demographics
NPI:1366502528
Name:WOLF, KAHLE, YUSK PSC
Entity Type:Organization
Organization Name:WOLF, KAHLE, YUSK PSC
Other - Org Name:BROWNSBORO PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:RENITA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-896-4459
Mailing Address - Street 1:4884 BROWNSBORO RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2342
Mailing Address - Country:US
Mailing Address - Phone:502-896-4459
Mailing Address - Fax:502-896-1164
Practice Address - Street 1:4884 BROWNSBORO RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2342
Practice Address - Country:US
Practice Address - Phone:502-896-4459
Practice Address - Fax:502-896-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65900037Medicaid
KY=========100OtherHUMANA CARESOURCE