| Kentuckianna Infectious Diseases Consultants Psc | |
|
125 Fairfax Ave Louisville KY 40207-4905 | |
| (502) 895-6155 | |
| (502) 895-6156 |
| Full Name | Kentuckianna Infectious Diseases Consultants Psc |
|---|---|
| Speciality | Internal Medicine - Infectious Disease |
| Location | 125 Fairfax Ave, Louisville, Kentucky |
| Authorized Official Name and Position | Barbara T Wojda (OWNER) |
| Authorized Official Contact | 5028956155 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kentuckianna Infectious Diseases Consultants Psc 125 Fairfax Ave Louisville KY 40207-4905 Ph: (502) 895-6155 | Kentuckianna Infectious Diseases Consultants Psc 125 Fairfax Ave Louisville KY 40207-4905 Ph: (502) 895-6155 |
| NPI Number | 1811908189 |
|---|---|
| Provider Enumeration Date | 08/11/2006 |
| Last Update Date | 03/13/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811908189 | NPI | - | NPPES |
| 64296734 | Medicaid | KY | |
| 000000228821 | Other | KY | BLUE CROSS/ ANTHEM |
| 1054531 | Other | KY | PASSPORT |
| 200209850A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | 29673 (Kentucky) | Primary |
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