Provider Demographics
NPI:1407982085
Name:HITTEPOLE, BRIDGET BERG (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:BERG
Last Name:HITTEPOLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E BROADWAY STE 290
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2040
Mailing Address - Country:US
Mailing Address - Phone:502-217-8221
Mailing Address - Fax:502-217-5056
Practice Address - Street 1:401 E CHESTNUT ST SUITE 370
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2040
Practice Address - Country:US
Practice Address - Phone:502-813-6800
Practice Address - Fax:502-562-6515
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42853207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3744367000OtherPASSPORT ADVANTAGE
KY7100085790Medicaid
KY000000635639OtherANTHEM
KY50026160OtherPASSPORT
IN200957520Medicaid
KY7100085790Medicaid