Provider Demographics
NPI:1336185354
Name:SECOR, TAMI (MD)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:
Last Name:SECOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604 LOWE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1514
Mailing Address - Country:US
Mailing Address - Phone:502-451-1401
Mailing Address - Fax:610-612-3302
Practice Address - Street 1:4604 LOWE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1514
Practice Address - Country:US
Practice Address - Phone:502-451-1401
Practice Address - Fax:610-612-3302
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35011208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64045792Medicaid
KY64045792Medicaid
KY00162020Medicare PIN