Individual
ALLEN DEAN HACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1850 BLUEGRASS AVE, LOUISVILLE, KY 40215-1161
(502) 367-3360
(502) 367-3365
Mailing address
6801 DIXIE HWY, SUITE 130, LOUISVILLE, KY 40258-3913
(502) 367-3360
(502) 367-3365
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25887
KY
208000000X
Pediatrics Physician
25887
KY
208M00000X
Hospitalist Physician
Primary
MD171953
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000633080
ANTHEM
KY
05
—
200961230A
—
IN
05
—
64258890
—
KY
Enumeration date
04/18/2006
Last updated
04/29/2016
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