Individual
MICHAEL D THEDFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4106 FLINTLOCK DR, LOUISVILLE, KY 40216-1534
(502) 715-6792
Mailing address
4106 FLINTLOCK DR, LOUISVILLE, KY 40216-1534
(502) 715-6792
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
1211944
KY
Other
Enumeration date
10/03/2023
Last updated
10/03/2023
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