| NPI | 1609655646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNETTA M TRAYLOR Administrator 502-596-6063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology |
| Enumeration Date | 2023-09-28 |
| Last Update Date | 2025-06-14 |