Organization
LOUISVILLE ENDOCRINOLOGY PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBORAH ANN BALLARD MD (PHYSICIAN PRESIDENT)
(502) 515-6621
Entity
Organization
Contact information
Practice address
3288 ILLINOIS AVE, SUITE 100, LOUISVILLE, KY 40213
(502) 515-6621
(502) 515-6620
Mailing address
3288 ILLINOIS AVE, SUITE 101, LOUISVILLE, KY 40213
(502) 515-6621
(502) 515-6620
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
KY26476
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000227457
ANTHEM
—
01
—
1162678
PASSPORT
—
01
—
2439678000
PASSPORT ADVANTAGE
—
Enumeration date
03/23/2007
Last updated
08/22/2020
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