Provider Demographics
NPI:1609422799
Name:BROSOF, LEIGH CARA
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:CARA
Last Name:BROSOF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 LEXINGTON RD UNIT 314
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2999
Mailing Address - Country:US
Mailing Address - Phone:215-870-7636
Mailing Address - Fax:
Practice Address - Street 1:11824 RANSUM DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2802
Practice Address - Country:US
Practice Address - Phone:502-205-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program