Organization
PEARL GERIATRICS AND PALLIATIVE MEDICINE, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OSAWARU JUDE OMORUYI M.D. (OWNER)
(502) 456-0494
Entity
Organization
Contact information
Practice address
2202 BUECHEL AVE STE 105, LOUISVILLE, KY 40218-2672
(502) 456-0494
(504) 456-0496
Mailing address
PO BOX 37188, LOUISVILLE, KY 40233-7188
(502) 456-0494
(502) 456-0496
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
39870
KY
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
3006777
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100134680
—
KY
05
—
7100159350
—
KY
Enumeration date
02/23/2010
Last updated
01/29/2021
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