Provider Demographics
NPI:1770896870
Name:HOUSE, FRED (SPECIALIST)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:HOUSE
Suffix:
Gender:M
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9604 FIRWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1027
Mailing Address - Country:US
Mailing Address - Phone:502-645-9231
Mailing Address - Fax:
Practice Address - Street 1:9604 FIRWOOD CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1027
Practice Address - Country:US
Practice Address - Phone:502-645-9231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-17
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1083707163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine