Individual
DYLAN P VISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
231 E CHESTNUT ST, LOUISVILLE, KY 40202-1821
(502) 629-8828
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 559-9337
(502) 272-5339
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
58986
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100830310
—
KY
Enumeration date
05/07/2019
Last updated
06/28/2024
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