Provider Demographics
NPI:1750777686
Name:WAHLGREN, BRETT T (MD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:T
Last Name:WAHLGREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5722 OUTER LOOP
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-4156
Mailing Address - Country:US
Mailing Address - Phone:502-492-7455
Mailing Address - Fax:502-921-0222
Practice Address - Street 1:5722 OUTER LOOP
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219
Practice Address - Country:US
Practice Address - Phone:502-492-7455
Practice Address - Fax:502-921-0222
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53134207LA0401X, 207L00000X
KYR3960207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine