Individual
DR. SUSAN S.B. TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2934 BRECKENRIDGE LN STE 2, LOUISVILLE, KY 40220-3903
(502) 454-7871
(502) 454-7872
Mailing address
2934 BRECKENRIDGE LN STE 2, LOUISVILLE, KY 40220-3903
(502) 454-7871
(502) 454-7872
Taxonomy
Speciality
Code
Description
License number
State
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
39021
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000337344
ANTHEM
KS
01
—
000000338030
ANTHEM
KY
05
—
200502730
—
IN
01
—
50004854
PASSPORT SPECIALITY
KY
01
—
50004926
PASSPORT PCP
KY
01
—
50015262
PASSPORT SPECIALITY
KY
05
—
64084148
—
KY
Enumeration date
07/14/2006
Last updated
09/29/2014
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