Individual
MARK TYE HAEBERLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3810 SPRINGHURST BLVD, SUITE 200, LOUISVILLE, KY 40241
(502) 583-1749
(502) 329-8184
Mailing address
PO BOX 950132, LOUISVILLE, KY 40295-0132
(888) 980-8992
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
47890
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100215390
—
KY
Enumeration date
04/04/2011
Last updated
07/17/2018
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