Provider Demographics
NPI:1134142896
Name:TISONE, JOSEPH A (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:TISONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1169 EASTERN PKWY
Mailing Address - Street 2:SUITE G 71
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1417
Mailing Address - Country:US
Mailing Address - Phone:502-458-8661
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:4000 KRESGE WAY STE P1503
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4605
Practice Address - Country:US
Practice Address - Phone:502-456-2008
Practice Address - Fax:502-456-4440
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36418207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0956501OtherCIGNA HEALTHCARE
KY1144199OtherPASSPORT MEDICAID
1301279OtherUNITED MINE WORKERS
290445OtherBLACK LUNG
WV9801803000Medicaid
KY64031354Medicaid
KY220030335OtherRAILROAD MEDICARE
000000190947OtherANTHEM BLUE CROSS BS
IN200101410AMedicaid
IN200101410AMedicaid
000000190947OtherANTHEM BLUE CROSS BS