Provider Demographics
NPI:1548225576
Name:TATE, DAVID E (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:TATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-969-6552
Mailing Address - Fax:502-212-1358
Practice Address - Street 1:315 E BROADWAY
Practice Address - Street 2:STE 195
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1703
Practice Address - Country:US
Practice Address - Phone:502-629-4263
Practice Address - Fax:502-629-4282
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32802207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY200822720OtherHEALTHY INDIANA PLAN- LOUISVILLE ARM AND HAND
KY64119571Medicaid
KY000000507566OtherANTHEM - LAH
KY069472OtherSIHO - LAH
KY2808156000OtherPASSPORT ADVANTAGE - LAH
KY50013626OtherPASSPORT - LAH
KYP00365516OtherRAILROAD MEDICARE
KY000023025UOtherHUAMANA - L:AH
IN200822720Medicaid
KY50013626OtherPASSPORT - LAH
KY2808156000OtherPASSPORT ADVANTAGE - LAH
IN200822720Medicaid