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Contact Information

MATTHEW T DESJARDINS, MD
560 S LOOP RD
EDGEWOOD, KY41017-3405
 Phone: 859-301-2663
 Fax: 859-301-0655
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine - Sports Medicine

207QS0010X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for MATTHEW T DESJARDINS · (Male)

NPI # 1699777847
Status Active
Credentials MD
Entity Individual
Enumeration date 06/01/2005
Last updated 05/11/2015 - About 11 years ago
Sole proprietor 1 No
Identifiers
  • KY License # 38980
  • KY Medicaid 64088594
  • KY Other 000000333833 ANTHEM
  • KY Other 90008962 MEDICAID DME
  • KY Other 0428850004 MEDICARE DME
  • KY Other CB8861 RAILROAD MEDICARE
  • KY Other P00156471 RAILROAD MEDICARE
Hospital affiliation(s)
  • ST ELIZABETH MEDICAL CENTER NORTH - (Acute Care)
    1 MEDICAL VILLAGE DRIVE
    LAKESIDE PARK, KY 41017
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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