Provider Demographics
NPI:1750782272
Name:PARUCH, THADDEUS PETER (PA-C)
Entity type:Individual
Prefix:MR
First Name:THADDEUS
Middle Name:PETER
Last Name:PARUCH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6420 DUTCHMANS PARKWAY
Mailing Address - Street 2:STE 390
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205
Mailing Address - Country:US
Mailing Address - Phone:502-259-9160
Mailing Address - Fax:502-371-0790
Practice Address - Street 1:6420 DUTCHMANS PARKWAY
Practice Address - Street 2:STE 390
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205
Practice Address - Country:US
Practice Address - Phone:502-259-9160
Practice Address - Fax:502-371-0790
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYTP292363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical