Provider Demographics
NPI:1265402002
Name:HOUSE, LOUIS TODD (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:TODD
Last Name:HOUSE
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 1:1064 EVERETT AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1272
Mailing Address - Country:US
Mailing Address - Phone:502-693-2037
Mailing Address - Fax:502-795-3507
Practice Address - Street 1:1064 EVERETT AVE APT 6
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1272
Practice Address - Country:US
Practice Address - Phone:502-693-2037
Practice Address - Fax:502-795-3507
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2015-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28276207L00000X
FLME93936207L00000X
CO31435207L00000X
MT10982207L00000X
IN01043742207L00000X
IA32621207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
421264647OtherFEIN
KY64878697Medicaid
KY64878697Medicaid
KYF26372Medicare UPIN