Provider Demographics
NPI:1255444741
Name:MORASSUTTI, DANTE J (MD)
Entity type:Individual
Prefix:
First Name:DANTE
Middle Name:J
Last Name:MORASSUTTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 DUTCHMANS LN
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4714
Mailing Address - Country:US
Mailing Address - Phone:502-899-6980
Mailing Address - Fax:502-899-6981
Practice Address - Street 1:4001 DUTCHMANS LN
Practice Address - Street 2:SUITE 1D
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4714
Practice Address - Country:US
Practice Address - Phone:502-899-6980
Practice Address - Fax:502-899-6981
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY30642174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY15J2OtherANTHEM
KY15J2OtherANTHEM
KY0613401Medicare ID - Type Unspecified