Provider Demographics
NPI:1578528246
Name:BOX, LOUISE M (MD)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:M
Last Name:BOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:E
Other - Last Name:MCGAVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:12615 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-4452
Practice Address - Country:US
Practice Address - Phone:502-261-1595
Practice Address - Fax:502-261-1599
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29848208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
000014952XOtherHUMANA / NCMA
KY2446866000OtherPASSPORT ADVANTAGE - NCMA
KY50005562OtherPASSPORT - NCMA
50025010OtherPASSPORT / NCMA TYLER
7398219OtherCIGNA / NCMA
KYP00219045OtherRAILROAD MEDICARE
048233OtherSIHO / NCMA
2446866000OtherPASSPORT ADVANTAGE / NCMA -TYLER
KY64298482Medicaid
1194518OtherCHA / NCMA
KY0000350819OtherANTHEM - NCMA
KY3729659000OtherPASSPORT ADVANGATE - TYLER
KY1361928Medicare PIN
KY2446866000OtherPASSPORT ADVANTAGE - NCMA