Organization
PREMIER ENT AND ALLERGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL DAVID COPPOLA MD (OWNER)
(502) 893-3683
Entity
Organization
Contact information
Practice address
2429 BUSH RIDGE DR STE 103, LOUISVILLE, KY 40245-5914
(502) 893-3683
Mailing address
2429 BUSH RIDGE DR STE 103, LOUISVILLE, KY 40245-5914
(502) 893-3683
(502) 893-1662
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
28995
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000045669
BCBS
KY
01
—
1052620
PASSPORT
KY
05
—
64289952
—
KY
01
—
CB0478
RR MEDICARE
KY
Enumeration date
03/23/2007
Last updated
01/10/2020
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