Provider Demographics
NPI:1629083399
Name:ASSOCIATES IN DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:ASSOCIATES IN DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JYOTI
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRUSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-583-1749
Mailing Address - Street 1:3810 SPRINGHURST BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6100
Mailing Address - Country:US
Mailing Address - Phone:502-583-1749
Mailing Address - Fax:502-329-8184
Practice Address - Street 1:3810 SPRINGHURST BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241
Practice Address - Country:US
Practice Address - Phone:502-583-1749
Practice Address - Fax:502-329-8184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100010640AMedicaid
KY000000059426OtherANTHEM
KY7100295380Medicaid
KY65912032Medicaid
KY0960Medicare PIN
KY65912032Medicaid