Provider Demographics
NPI:1366438707
Name:UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC
Entity type:Organization
Organization Name:UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-852-1174
Mailing Address - Street 1:PO BOX 3311
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-3311
Mailing Address - Country:US
Mailing Address - Phone:502-852-1174
Mailing Address - Fax:502-852-2046
Practice Address - Street 1:511 S. FLOYD STREET
Practice Address - Street 2:ROOM 203
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40292-0001
Practice Address - Country:US
Practice Address - Phone:502-852-5519
Practice Address - Fax:502-852-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200123291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4016301OtherMEDICARE PTAN
KY4016301OtherMEDICARE PTAN