National Provider Identifier Database

JEREMY J CLARK, MD – NPI #1588717417
Gynecology

A physician who specializes in diagnosis, treatment, and management of patients with gynecologic conditions.

Contact Information

JEREMY J CLARK, MD
401 E CHESTNUT ST
SUITE 410
LOUISVILLE, KY  40202-5700
Phone: 502-271-5999
Fax: 502-271-5994
Website:
Specialty Taxonomy Code
* Gynecology 207VG0400X

* Indicates primary specialty

NPI Profile & details for JEREMY J CLARK

NPI Number 1588717417
Credentials MD
Entity Individual
Enumeration date 01/22/2007
Last updated 11/29/2021 - About 5 years ago
Sole proprietor1 No
Identifiers
  • KY License #: 41069
  • IN Medicaid: 200868450
  • KY Medicaid: 7100013410
  • Other: 7290926 AETNA
  • Other: 000001568F HUMANA PSC
  • Other: 000001172T HUMANA FOUNDATION
  • KY Other: 000000522820 ANTHEM FOUNDATION
  • KY Other: 000000542980 ANTHEM - PSC
  • KY Other: 50017315 PASSPORT PCP# - FOUNDATION
  • KY Other: 50016301 PASSPORT SPECIALITY - PSC
  • KY Other: 50016302 PASSPORT SPECIALITY# -FOUNDATION
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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