Provider Demographics
NPI:1407833940
Name:BRETZ, ROBERT D (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:BRETZ
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 1:879 OLD PRESTON HIGHWAY NORTH
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229
Mailing Address - Country:US
Mailing Address - Phone:502-955-6480
Mailing Address - Fax:502-955-6480
Practice Address - Street 1:879 OLD PRESTON HIGHWAY NORTH
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229
Practice Address - Country:US
Practice Address - Phone:502-955-6480
Practice Address - Fax:502-955-6480
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY263362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100353580Medicaid
KY64263361Medicaid
KY64263361Medicaid
KY699213Medicare PIN