Individual
DR. DWIGHT PRIDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4123 DUTCHMANS LN, SUITE 300, LOUISVILLE, KY 40207
(502) 899-6755
(502) 899-6753
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5339
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
25165
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64251655
—
KY
01
—
K024740
MEDICARE PTAN- WOMEN'S SPECIALISTS
KY
Enumeration date
07/13/2005
Last updated
12/21/2021
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