Individual
SERGEI VENIAMINOVICH DMITRUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4010 DUPONT CIR STE 380, LOUISVILLE, KY 40207-4881
(502) 895-0040
(502) 214-3429
Mailing address
1935 BLUEGRASS AVE STE 200, LOUISVILLE, KY 40215-1181
(502) 364-0033
(502) 361-4488
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
01085592A
IN
207W00000X
Ophthalmology Physician
Primary
54890
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300050894
—
IN
05
—
7100740700
—
KY
Enumeration date
04/12/2017
Last updated
10/17/2024
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