Provider Demographics
NPI:1700347341
Name:SADLE, CHARLES JAKE (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:JAKE
Last Name:SADLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:OFFICE OF MEDICAL EDUCATION C/O BRITTNEY LUCKETT
Mailing Address - Street 2:571 S. FLOYD ST., STE. 412
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-629-8828
Mailing Address - Fax:
Practice Address - Street 1:OFFICE OF MEDICAL EDUCATION C/O BRITTNEY LUCKETT
Practice Address - Street 2:571 S. FLOYD ST., STE. 412
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:503-803-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program