Individual
DR. BERNARD LOUIS SPEEVACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
417 BENJAMIN LANE, SUITE 101, LOUISVILLE, KY 40222-4845
(502) 412-0597
(502) 412-4637
Mailing address
417 BENJAMIN LANE, SUITE 101, LOUISVILLE, KY 40222-4845
(502) 412-0597
(502) 412-4637
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
20887
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000652903
ANTHEM
KY
01
—
000000768482
ANTHEM - NICC
KY
01
—
135410
SIHO - NICC
KY
01
—
50028108
PASSPORT
KY
05
—
64208879
—
KY
Enumeration date
10/20/2005
Last updated
09/08/2020
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