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Individual

MICHAEL W SUTKAMP

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
4002 KRESGE WAY, STE 124, LOUISVILLE, KY 40207-4661
(502) 238-2801
(502) 238-2835
Mailing address
PO BOX 950248, LOUISVILLE, KY 40295-0248
(502) 489-5730
(502) 489-5753

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
30310
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000350550
ANTHEM - NMA
KY
01
000052155E
HUMANA / NMA
01
009110
SIHO - NMA
KY
01
1063095
PASSPORT - NMA
KY
01
1193585
CHA / NMA
01
2434332000
PASSPORT ADVANTAGE - NMA
KY
01
2540713001
CIGNA / NMA
05
64303100
KY
01
P00176908
RAILROAD MEDICARE
KY
Enumeration date
04/17/2006
Last updated
01/26/2015
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