Organization
UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC.
Active
Other names
WINGS Clinic, ULRF WINGS Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TONI GANZEL MD (VP OF HEALTH AFFAIRS)
(502) 852-5555
Entity
Organization
Contact information
Practice address
550 S JACKSON ST, ACB 2ND FLOOR, LOUISVILLE, KY 40202-1622
(502) 561-8844
(502) 589-5093
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0320
(502) 217-5056
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700115800 (PAS)
—
KY
05
—
200925390
—
IN
01
—
3541914000
PASSPORT ADVANTAGE
KY
01
—
50020689
PASSPORT HEALTH PLAN
KY
01
—
522843
ANTHEM
KY
05
—
7100083550 (MDS)
—
KY
Enumeration date
08/07/2007
Last updated
12/21/2021
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