Provider Demographics
NPI:1184726085
Name:ODLE, TARA L (MD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:L
Last Name:ODLE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 6749
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-0749
Mailing Address - Country:US
Mailing Address - Phone:502-899-7646
Mailing Address - Fax:502-899-7648
Practice Address - Street 1:4000 KRESGE WAY
Practice Address - Street 2:EMERGENCY DEPARTMENT BAPTIST HEALTH LOUISVILLE
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4605
Practice Address - Country:US
Practice Address - Phone:502-899-7646
Practice Address - Fax:502-899-7648
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35847207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200355490Medicaid
KY64042492Medicaid
KY35847OtherKY LICENSE
KY000000786307OtherANTHEM BC/BS
KY50042929OtherPASSPORT
BO6816233OtherDEA
KY64042492Medicaid
IN200355490Medicaid
H52232Medicare UPIN