Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 23369 | KY |
NPI | 1093719866 |
---|---|
Provider Name | Dr. Thomas M Bergamini |
First Address | Louisville, KY 40207-4652 |
Second Address | Louisville, KY 40207-4652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 07/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64233695 | (05) | KY |
C71315 | (02) | KY |