Organization
MD2U PLLC
Active
Other names
MD2U Doctors Who Make House Calls
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY DAVID LATTA (BILLING MANAGER)
(502) 327-9100
Entity
Organization
Contact information
Practice address
105 CRESCENT AVE, LOUISVILLE, KY 40206-1525
(502) 327-9100
(502) 742-3767
Mailing address
105 CRESCENT AVE, LOUISVILLE, KY 40206-1525
(502) 327-9100
(502) 742-3767
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
01056286A
IN
261QP2300X
Primary Care Clinic/Center
Primary
38836
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000365262
BCBS PIN
KY
01
—
2448540000
PASSPORT ADVANTAGE #
KY
01
—
50007387
PASSPORT #
KY
05
—
7100037890
—
KY
01
—
DD3382
RAILROAD MEDICARE PIN
KY
Enumeration date
08/14/2006
Last updated
06/30/2009
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