Provider Demographics
NPI:1477509891
Name:LOUISVILLE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:LOUISVILLE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JANOCIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-895-4772
Mailing Address - Street 1:3950 KREGGE WAY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-895-4772
Mailing Address - Fax:502-895-8396
Practice Address - Street 1:3950 KREGGE WAY
Practice Address - Street 2:SUITE 303
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-895-4772
Practice Address - Fax:502-895-8396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25901207R00000X
KY35865207R00000X
KY32690207R00000X
KY28032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty