Provider Demographics
NPI:1568460715
Name:LITVAN, IRENE (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:LITVAN
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 1:401 E CHESTNUT ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5700
Mailing Address - Country:US
Mailing Address - Phone:502-589-0802
Mailing Address - Fax:502-589-0805
Practice Address - Street 1:220 ABRAHAM FLEXNER WAY
Practice Address - Street 2:SUITE 1503
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3826
Practice Address - Country:US
Practice Address - Phone:502-589-0802
Practice Address - Fax:502-589-0805
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY377022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64060437Medicaid
KY64060437Medicaid
KY0050840Medicare ID - Type Unspecified