Organization
SUSAN B TATE MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN B TATE MD (OWNER)
(502) 454-7871
Entity
Organization
Contact information
Practice address
2934 BRECKENRIDGE LN, SUITE 2, LOUISVILLE, KY 40220-3903
(502) 454-7871
(502) 454-7872
Mailing address
2934 BRECKENRIDGE LN, SUITE 2, LOUISVILLE, KY 40220-3903
(502) 454-7871
(502) 454-7872
Taxonomy
Speciality
Code
Description
License number
State
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
39021
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64084148
—
KY
Enumeration date
03/12/2014
Last updated
03/12/2014
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