Individual
DR. SMITHA BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
601 S FLOYD ST, SUITE 602, LOUISVILLE, KY 40202-1845
(502) 585-4802
(502) 589-1256
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 585-4802
(502) 589-1256
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
45511
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100224090
—
KY
Enumeration date
06/04/2008
Last updated
10/13/2020
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