Individual
MICHAEL ELI PENDLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
215 CENTRAL AVE STE 100, LOUISVILLE, KY 40208
(502) 588-8720
(502) 588-8721
Mailing address
5200 COMMERCE CROSSINGS DR FL 3, LOUISVILLE, KY 40229-2182
(502) 253-4924
(502) 489-5750
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
43483
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50029698
PASSPORT HEALTH PLAN
KY
01
—
50029699
PASSPORT HEALTH PLAN
KY
01
—
50029700
PASSPORT HEALTH PLAN
KY
01
—
50029701
PASSPORT HEALTH PLAN
KY
05
—
7100127990
—
KY
Enumeration date
05/08/2007
Last updated
12/07/2020
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