Organization
UNIVERSITY PEDIATRIC PULMONARY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERARD P. RABALAIS MD (CHAIRMAN)
(502) 852-8600
Entity
Organization
Contact information
Practice address
9700 PARK PLAZA AVE, STE 110, LOUISVILLE, KY 40241-2286
(502) 629-8830
(502) 629-7540
Mailing address
PO BOX 2469, LOUISVILLE, KY 40201-2469
(502) 852-8500
(502) 852-8556
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2080P0214X
Pediatric Pulmonology Physician
Primary
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200998250
—
IN
05
—
7100115770
—
KY
05
—
710018920
—
KY
Enumeration date
02/15/2011
Last updated
02/15/2011
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