Provider Demographics
NPI:1295173417
Name:GALVIS, JUAN MANUEL (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:GALVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-4710
Mailing Address - Fax:502-588-4771
Practice Address - Street 1:401 E CHESTNUT ST UNIT 690
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5706
Practice Address - Country:US
Practice Address - Phone:502-588-4710
Practice Address - Fax:502-588-4771
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49201207R00000X, 207RP1001X
TXBP10047612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY49201OtherMEDICAL LICENSE