Provider Demographics
NPI:1386975183
Name:ZHAO, MINGLU (MSPA)
Entity type:Individual
Prefix:MRS
First Name:MINGLU
Middle Name:
Last Name:ZHAO
Suffix:
Gender:F
Credentials:MSPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6513 TURNBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8872
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:800 ZORN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1433
Practice Address - Country:US
Practice Address - Phone:502-287-4772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2960363AM0700X
IL085003563363A00000X
VA0110003385363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109719Medicaid
IL094621OtherHEALTH ALLIANCE
IL10019630OtherBLUECROSS/BLUESHIELD
ILP00166778OtherRAILROAD MEDICARE
IL657869OtherHEATHLINK
IL036109719Medicaid
ILH99697Medicare UPIN