PEARL MEDICAL PRACTICE PLLC NPI 1114261203

NPI Information

PEARL MEDICAL PRACTICE PLLC is a primary care clinic center in Louisville, KY. PEARL MEDICAL PRACTICE PLLC NPI is 1114261203. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4200 GARDINER VIEW AVE
SUITE 200
LOUISVILLE, KY
ZIP 40213-877
Phone: (502) 456-0494
Fax: (502) 456-0496

The provider's authorized official is Osawaru Omoruyi .
The authorized official title is President and has the following contact phone number (502) 456-0494.

The CLIA number assigned to this NPI record is 18D2150043 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/15/2012 and was last updated on 10/2/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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