Provider Demographics
NPI:1417043431
Name:UHLENHUTH, ERIC R (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:R
Last Name:UHLENHUTH
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 1:1900 BLUEGRASS AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215
Mailing Address - Country:US
Mailing Address - Phone:502-375-0009
Mailing Address - Fax:502-375-2150
Practice Address - Street 1:1900 BLUEGRASS AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215
Practice Address - Country:US
Practice Address - Phone:502-375-0009
Practice Address - Fax:502-375-2150
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22396208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
6112309457A11OtherANTHEM SENIOR
KY1043937OtherPASSPORT
2292157001OtherCIGNA
6112309457B11OtherANTHEM SENIOR
000000042788OtherANTHEM
KY64223969Medicaid
KY1106100OtherPASSPORT
KY65909285Medicaid
2292157001OtherCIGNA
KY64223969Medicaid
0615301Medicare ID - Type Unspecified