Organization
LOUISVILLE NEUROSURGICAL SPECIALIST PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID PETRUSKA MD (OWNER PHYSICIAN)
(502) 899-9099
Entity
Organization
Contact information
Practice address
4010 DUPONT CIR, SUITE L28, LOUISVILLE, KY 40207-4812
(502) 899-9099
(502) 899-9899
Mailing address
4010 DUPONT CIR, SUITE L28, LOUISVILLE, KY 40207-4812
(502) 899-9099
(502) 899-9899
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
24702
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50001903
PASSPORT ID
—
Enumeration date
01/29/2007
Last updated
08/20/2007
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