Organization
PUERTO MEDICAL GROUP PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALFONSO PUERTO MD (PRESIDENT)
(502) 899-1246
Entity
Organization
Contact information
Practice address
10806 WARD AVE, LOUISVILLE, KY 40223-2659
(502) 899-1246
(234) 567-4229
Mailing address
PO BOX 436809, LOUISVILLE, KY 40253-6809
(502) 899-1246
(234) 567-4229
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
LL339
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669415808
INDIVIDUAL NPI
KY
Enumeration date
12/04/2010
Last updated
12/08/2011
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