Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 33135 | KY |
NPI | 1013912674 |
---|---|
Provider Name | Michael R Recto |
First Address | Louisville, KY 40202-1845 |
Second Address | Louisville, KY 40202-1845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 28/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200156100A | (05) | IN |
64331358 | (05) | KY |
G76351 | (02) | KY |