Organization
THEODORE M WANDZILAK MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAM SMITH (MANAGER)
(502) 634-1721
Entity
Organization
Contact information
Practice address
1348 POPLAR LEVEL RD, LOUISVILLE, KY 40217-1307
(502) 634-1721
(502) 637-6396
Mailing address
1348 POPLAR LEVEL RD, LOUISVILLE, KY 40217-1307
(502) 634-1721
(502) 637-6396
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
22152
KY
Other
Enumeration date
01/30/2008
Last updated
06/08/2017
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