Provider Demographics
NPI:1659598159
Name:LOUISVILLE HEART SURGERY, PLLC
Entity Type:Organization
Organization Name:LOUISVILLE HEART SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-634-0072
Mailing Address - Street 1:2355 POPLAR LEVEL RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1395
Mailing Address - Country:US
Mailing Address - Phone:502-634-0072
Mailing Address - Fax:502-636-7130
Practice Address - Street 1:2355 POPLAR LEVEL RD
Practice Address - Street 2:SUITE 305
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1395
Practice Address - Country:US
Practice Address - Phone:502-634-0072
Practice Address - Fax:502-636-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10000011510AMedicaid