Provider Demographics
NPI:1578568739
Name:KIRTLEY, LOUIS R (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:R
Last Name:KIRTLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4130 DUTCHMANS LN
Practice Address - Street 2:STE 400
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4711
Practice Address - Country:US
Practice Address - Phone:502-897-0697
Practice Address - Fax:502-897-0658
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20700207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64207004Medicaid
KY0700073OtherUNITED HEALTHCARE
KY160032458OtherRAILROAD
KYP01140466OtherMEDICARE RR - WS
KY1063797OtherPASSPORT
KY50036613OtherPASSPORT - WS
KY160032458OtherRAILROAD
KY50036613OtherPASSPORT - WS
KY1063797OtherPASSPORT
KY1267804Medicare ID - Type UnspecifiedMEDICARE
KYC72593Medicare UPIN