Organization
TRI STATE NEUROLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN DOUGLAS DEITCH M.D. (OWNER)
(606) 836-5565
Entity
Organization
Contact information
Practice address
1450 DIEDERICH BLVD, RUSSELL, KY 41169-1719
(606) 836-5565
(606) 836-5567
Mailing address
1450 DIEDERICH BLVD, RUSSELL, KY 41169-1719
(606) 836-5565
(606) 836-5567
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
26535
KY
Other
Enumeration date
11/20/2014
Last updated
11/21/2014
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