Organization
UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC
Active
Other names
Special Procedures Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOSTAFA FRAIG M.D. (MEDICAL DIRECTOR)
(502) 852-1174
Entity
Organization
Contact information
Practice address
511 S. FLOYD STREET, ROOM 203, LOUISVILLE, KY 40292-0001
(502) 852-5519
(502) 852-1171
Mailing address
PO BOX 3311, LOUISVILLE, KY 40201-3311
(502) 852-1174
(502) 852-2046
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
200123
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4016301
MEDICARE PTAN
KY
Enumeration date
09/21/2005
Last updated
12/19/2012
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