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Contact Information

JEREMY J CLARK, MD
401 E CHESTNUT ST
SUITE 410
LOUISVILLE, KY40202-5700
 Phone: 502-271-5999
 Fax: 502-271-5994
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Gynecology

207VG0400X 16 Physician/Obstetrics & Gynecology
Indicates primary specialty

NPI Profile & details for JEREMY J CLARK · (Male)

NPI Number 1588717417
Status Active
Credentials MD
Entity Individual
Enumeration date 01/22/2007
Last updated 11/29/2021 - About 5 years ago
Sole proprietor 1 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(s) Not Available
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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