Individual
DR. JAMES ANTHONY TAVELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5211 COMMERCE CROSSINGS DR, LOUISVILLE, KY 40229-2183
(502) 966-3918
(502) 969-3665
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
41964
KY
208000000X
Pediatrics Physician
R1109
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000845603
ANTHEM-NCMA
KY
01
—
131041
SIHO-NCMA
KY
05
—
201221770
—
IN
01
—
50061769
PASSPORT-NCMA
KY
05
—
7100272550
—
KY
01
—
K097431
MEDICARE
KY
Enumeration date
03/05/2007
Last updated
09/21/2022
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