Provider Demographics
NPI:1427443589
Name:HUELSMAN, MEAGAN HOLTGRAVE (MD)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:HOLTGRAVE
Last Name:HUELSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:MARIE
Other - Last Name:HOLTGRAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2811 KLEMPNER WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-4203
Mailing Address - Country:US
Mailing Address - Phone:502-896-6355
Mailing Address - Fax:
Practice Address - Street 1:2811 KLEMPNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-4203
Practice Address - Country:US
Practice Address - Phone:502-896-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-05
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY52285207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology