Organization
MARK O GLADSTEIN MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK O GLADSTEIN M.D. (PHYSICIAN)
(502) 589-4448
Entity
Organization
Contact information
Practice address
250 E LIBERTY ST, SUITE 1005, LOUISVILLE, KY 40202-1538
(502) 589-4448
(502) 589-1209
Mailing address
250 E LIBERTY ST, SUITE 1005, LOUISVILLE, KY 40202-1538
(502) 589-4448
(502) 589-1209
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1059292
—
KY
01
—
20041432
RR MEDICARE
—
05
—
50009936
—
KY
05
—
64144546
—
KY
05
—
9001304600
—
KY
Enumeration date
04/16/2007
Last updated
12/23/2009
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