Organization
SPECIALTY ORTHOPAEDICS PSC
Active
Other names
Kentuckiana Foot & Ankle Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS MATTHEW GABRIEL MD (PRESIDENT)
(502) 721-8288
Entity
Organization
Contact information
Practice address
6400 DUTCHMANS PKWY, SUITE 215, LOUISVILLE, KY 40205-3340
(502) 721-8288
(502) 721-8792
Mailing address
6400 DUTCHMANS PKWY, SUITE 215, LOUISVILLE, KY 40205-3340
(502) 721-8288
(502) 721-8792
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
00251
KY
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80900293
GRP PODIATRY MEDICAID
KY
Enumeration date
12/27/2006
Last updated
05/02/2008
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