Provider Demographics
NPI:1497743041
Name:UROGYNECOLOGY SPECIALISTS OF KENTUCKIANA
Entity Type:Organization
Organization Name:UROGYNECOLOGY SPECIALISTS OF KENTUCKIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-897-2392
Mailing Address - Street 1:4121 DUTCHMANS LN
Mailing Address - Street 2:STE 515
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4707
Mailing Address - Country:US
Mailing Address - Phone:502-897-2392
Mailing Address - Fax:502-897-2311
Practice Address - Street 1:4121 DUTCHMANS LN
Practice Address - Street 2:STE 515
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4707
Practice Address - Country:US
Practice Address - Phone:502-897-2392
Practice Address - Fax:502-897-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9067Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER