Provider Demographics
NPI:1023409612
Name:DERMATOPATHOLOGY CONSULTANTS OF KENTUCKY PLLC
Entity type:Organization
Organization Name:DERMATOPATHOLOGY CONSULTANTS OF KENTUCKY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TJ
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-495-1162
Mailing Address - Street 1:2307 GREENE WAY STE C
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-4097
Mailing Address - Country:US
Mailing Address - Phone:502-806-3376
Mailing Address - Fax:502-495-0156
Practice Address - Street 1:2307 GREENE WAY STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4097
Practice Address - Country:US
Practice Address - Phone:502-806-3376
Practice Address - Fax:502-495-0156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207ND0900X
363A00000X, 363L00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty