Individual
MARX WENDEL GONCALVES DE SA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
530 S JACKSON ST, LOUISVILLE, KY 40202-1675
(502) 852-1735
(502) 852-6056
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328
(502) 587-4784
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
53805
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300041839
—
IN
05
—
7100681580
—
KY
Enumeration date
01/22/2014
Last updated
09/02/2020
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