Individual
MR. THADDEUS BEAM RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
947 EASTERN PKWY, LOUISVILLE, KY 40217-1573
(502) 361-8801
(502) 361-8821
Mailing address
947 EASTERN PKWY, LOUISVILLE, KY 40217-1573
(502) 361-8801
(502) 361-8821
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1070
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144417999
NPI
KY
Enumeration date
09/25/2007
Last updated
11/27/2023
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