Individual
WAYNE MARTIN SHUGOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4915 NORTON HEALTHCARE BLVD STE 202, LOUISVILLE, KY 40241-2832
(502) 891-8300
(502) 394-6525
Mailing address
PO BOX 766351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
01038751
IN
207RC0000X
Cardiovascular Disease Physician
Primary
27375
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000049358
ANTHEM
KY
05
—
100344830
—
IN
05
—
1050461
—
KY
05
—
64273758
—
KY
01
—
P00992206
RAILROAD MEDICARE
KY
Enumeration date
05/19/2006
Last updated
01/21/2021
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