Organization
LOUISVILLE PATIENT CENTERED MEDICAL HOME, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES D. CHARASIKA M.D. (PRESIDENT/CEO)
(502) 896-8041
Entity
Organization
Contact information
Practice address
4010 DUPONT CIR, SUITE 308, LOUISVILLE, KY 40207-4812
(502) 896-8041
(502) 896-8044
Mailing address
4010 DUPONT CIR, SUITE 308, LOUISVILLE, KY 40207-4812
(502) 896-8041
(502) 896-8044
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18988
KY
261QP2300X
Primary Care Clinic/Center
18988
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043299514
NPI
KY
Enumeration date
03/25/2008
Last updated
12/27/2013
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