Individual
DR. ANDREW L DEGRUCCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9370 CEDAR CENTER WAY, LOUISVILLE, KY 40291
(502) 762-9528
(502) 762-9529
Mailing address
9370 CEDAR CENTER WAY, LOUISVILLE, KY 40291
(502) 762-9528
(502) 762-9529
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
29694
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000044579
ANTHEM PROVIDER NUMBER
KY
01
—
6798413002
CIGNA
KY
Enumeration date
07/07/2006
Last updated
11/23/2007
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