Provider Demographics
NPI:1659653590
Name:LOUISVILLE CONCIERGE MEDICINE, PLLC
Entity Type:Organization
Organization Name:LOUISVILLE CONCIERGE MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:KARAGEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-618-3535
Mailing Address - Street 1:10325 CHAMPION FARMS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6129
Mailing Address - Country:US
Mailing Address - Phone:502-618-3535
Mailing Address - Fax:502-618-3537
Practice Address - Street 1:10325 CHAMPION FARMS DRIVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-6129
Practice Address - Country:US
Practice Address - Phone:502-618-3535
Practice Address - Fax:502-618-3537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32573207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYDS6356OtherRAILROAD MEDICARE
KY000000739235OtherANTHEM
KYK015080Medicare PIN