Provider Demographics
NPI:1053605394
Name:DEETSCH, TODD DOUGLAS
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:DOUGLAS
Last Name:DEETSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 LINNEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1014
Mailing Address - Country:US
Mailing Address - Phone:502-693-1037
Mailing Address - Fax:502-245-2490
Practice Address - Street 1:208 LINNEY AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1014
Practice Address - Country:US
Practice Address - Phone:502-693-1037
Practice Address - Fax:502-245-2490
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor