Organization
PEARL GERIATRICS AND PALLIATIVE MEDICINE, PSC
Active
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
Update your record
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