Organization
PEDIATRIC PULMONARY MEDICINE, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NEMR EID MD (OWNER OF PRACTICE)
(502) 852-3772
Entity
Organization
Contact information
Practice address
234 EAST GRAY STREET, SUITE 270, LOUISVILLE, KY 40202
(502) 852-3772
(502) 852-4051
Mailing address
6801 DIXIE HIGHWAY, SUITE 130, LOUISVILLE, KY 40258
(502) 451-5855
(502) 479-1409
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
25574
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1050575
PASSPORT GROUP NUMBER
KY
05
—
65921991
—
KY
Enumeration date
12/12/2006
Last updated
08/22/2020
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