Organization
EAST LOUISVILLE NEUROLOGY, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUANITA BLAKEMAN (BILLING MANAGER)
(502) 254-4014
Entity
Organization
Contact information
Practice address
13806 LAKE POINT CIRCLE, SUITE 101, LOUISVILLE, KY 40223
(502) 254-4014
(502) 254-4015
Mailing address
PO BOX 23568, LOUISVILLE, KY 40223
(502) 245-4014
(502) 245-4015
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
2084N0400X
KY
2084N0400X
Neurology Physician
Primary
32411
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64324114
—
KY
Enumeration date
06/16/2008
Last updated
01/15/2014
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