Individual
JANELLE MARIE FASSBENDER ADENIRAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1935 BLUEGRASS AVE STE 200, LOUISVILLE, KY 40215
(502) 364-0033
Mailing address
1935 BLUEGRASS AVE STE 200, LOUISVILLE, KY 40215-1181
(502) 364-0033
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
01080878A
IN
207W00000X
Ophthalmology Physician
Primary
49029
KY
207WX0107X
Retina Specialist (Ophthalmology) Physician
01080878A
IN
207WX0107X
Retina Specialist (Ophthalmology) Physician
49029
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201397580
—
IN
05
—
7100257450
—
KY
Enumeration date
06/12/2012
Last updated
08/20/2020
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