Individual
BRIAN M DERHAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 ABRAHAM FLEXNER WAY, LOUISVILLE, KY 40202-2877
(502) 587-4404
(502) 587-4156
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
44405
KY
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
44405
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201226160
—
IN
05
—
7100161850
—
KY
01
—
K017671
MEDICARE
KY
Enumeration date
02/13/2007
Last updated
06/29/2022
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