Individual
JOSHUA BRANDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3101 POPLAR LEVEL RD STE 101, LOUISVILLE, KY 40213-1076
(502) 636-7444
(502) 636-7112
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125075684
IL
207Q00000X
Family Medicine Physician
Primary
58196
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58196
STATE LICENSE
KY
05
—
7100911900
—
KY
Enumeration date
05/08/2020
Last updated
12/06/2023
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