ETHAN WADE BLACKBURN (NPI# 1538387360) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538387360 |
| Entity Type | Individual |
| Full Name | ETHAN WADE BLACKBURN |
| Credential | MD |
| Practice Address |
315 E Broadway Ste 195 Louisville KY 40202-3700 |
| Mailing Address |
Po Box 776351 Chicago IL 60677-6351 |
| Practice Telephone | 5026294263 |
| Practice Fax Number | 5026294282 |
| Mailing Telephone | 5025889490 |
| Mailing Fax Number | 5022725116 |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2016-07-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | 45826 | KY | Allopathic & Osteopathic Physicians |
| N | 207X00000X | Orthopaedic Surgery | 01071401B | IN | Allopathic & Osteopathic Physicians |
| Y | 207XS0106X |
Orthopaedic Surgery Specialization: Hand Surgery |
45826 | KY | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | SIHO | 149325 | 01 |
| KY | 7100250140 | 05 | |
| KY | PASSPORT | 50052189 | 01 |
| KY | ANTHEM - LAH | 000000833108 | 01 |
| Street Address |
315 E BROADWAY STE 195 |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40202-3700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992832729 | Julie A Ward | Nurse Practitioner | 315 E Broadway Ste 195, Louisville, KY 40202-1703 | 2007-02-28 |
| 1043775521 | Sn Kentuckiana Rehab, LLC | Durable Medical Equipment & Medical Supplies | 315 E Broadway Ste 195, Louisville, KY 40202-3700 | 2019-02-08 |
| 1578036976 | Sn Kentuckiana Rehab, LLC | Clinic/Center | 315 E Broadway Ste 195, Louisville, KY 40202-3700 | 2019-01-08 |
| 1801096839 | Rhonda M Curry | Occupational Therapist | 315 E Broadway Ste 195, Louisville, KY 40202-3700 | 2007-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972129682 | Garvit Chhabra | Student in an Organized Health Care Education/Training Program | 550, South Jackson Street, Acb, Third Floor, Louisville, KY 40202 | 2020-06-18 |
| 1396367009 | Richele Williams | Student in an Organized Health Care Education/Training Program | 201 Abraham Flexner Way Department of Family and Pediac, Suite 690, Louisville, KY 40202 | 2020-05-15 |
| 1942822028 | Ahmed Khaled Saleh | Student in an Organized Health Care Education/Training Program | 500 S Jackson St, Room 305, Louisville, KY 40202 | 2020-05-12 |
| 1457972952 | Mir Ali Raza Talpur | Student in an Organized Health Care Education/Training Program | 401 E Chestnut Street, Suite 600 University of Louisvi, Louisville, KY 40202 | 2020-05-06 |
| 1316575533 | Abigail Hatfield | Student in an Organized Health Care Education/Training Program | Internal Medicine Training Program, 550 South Jackson Street, Acb 3rd Floor, Louisville, KY 40202 | 2020-04-01 |
| 1851929210 | Madison Harmon | Student in an Organized Health Care Education/Training Program | Uofl Department of Emergency Medicine, 530 S. Jackson Street Room C1h17, Louisville, KY 40202 | 2020-03-31 |
| 1184252041 | Marianna Weaver | Student in an Organized Health Care Education/Training Program | 550 South Jackson Street, Acb 3rd Floor, University of Louisville, Louisville, KY 40202 | 2020-03-27 |
| 1700347341 | Charles Jake Sadle | Student in an Organized Health Care Education/Training Program | Office of Medical Education C/o Brittney Luckett, 571 S. Floyd St., Ste. 412, Louisville, KY 40202 | 2019-03-27 |
| 1437616794 | Paladina Health, LLC | Family Medicine | Paladina Health Humana East, 123 E Main Street, Louisville, KY 40202 | 2019-02-22 |
| 1205393568 | Paladina Health, LLC | Family Medicine | Paladina Health Humana West, 500 W Main Street, Louisville, KY 40202 | 2019-02-22 |
| Find all providers in zip 40202 | ||||
| Taxonomy Code | 207XS0106X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Hand Surgery |
| An orthopaedic surgeon trained in the investigation, preservation and restoration by medical, surgical and rehabilitative means of all structures of the upper extremity directly affecting the form and function of the hand and wrist. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881825636 | Emilie Mailhot | Orthopaedic Surgery | 225 Abraham Flexner Way Ste 850, Louisville, KY 40202-1858 | 2009-07-28 |
| 1528678513 | Laura L Cardenas Mateus | Orthopaedic Surgery | 225 Abraham Flexner Way Ste 850, Louisville, KY 40202-1858 | 2020-08-04 |
| 1720633381 | Kjell Van Royen | Orthopaedic Surgery | 225 Abraham Flexner Way Ste 850, Louisville, KY 40202-1858 | 2019-08-09 |
| 1497300057 | Ahmed Hany Mohamed Tawfik Elhessy | Orthopaedic Surgery | 225 Abraham Flexner Way Ste 850, Louisville, KY 40202-1858 | 2019-08-09 |
| 1740842897 | Jongmin Kim | Orthopaedic Surgery | 225 Abraham Flexner Way Ste 850, Louisville, KY 40202-1858 | 2019-06-28 |
| 1265093496 | Mario A Almaraz | Orthopaedic Surgery | 225 Abraham Flexner Way Ste 850, Louisville, KY 40202-1858 | 2019-06-27 |
| 1417443730 | Ahmed Al Wahaibi | Orthopaedic Surgery | 225 Abraham Flexner Way Ste 850, Louisville, KY 40202-3840 | 2018-07-10 |
| 1003302316 | Jose Javier Banda Mendoza | Orthopaedic Surgery | 225 Abraham Flexner Way Ste 850, Louisville, KY 40202-1858 | 2018-07-10 |
| 1639665953 | Maria Cristina De Obeso Espino Barros | Orthopaedic Surgery | 225 Abraham Flexner Way Ste 850, Louisville, KY 40202-3840 | 2018-07-10 |
| 1952810681 | Shiro Yoshida | Orthopaedic Surgery | 225 Abraham Flexner Way, Suite 850, Louisville, KY 40202 | 2017-09-26 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40202 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.