| NPI | 1164645834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA J. DISTLER Physician/Owner 502-244-9858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: KY 28883) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: KY 38964) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: KY 39163) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2014-03-12 |