Individual
MARK A BROCKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5109 NEW CUT RD, LOUISVILLE, KY 40214-2745
(502) 361-1197
(502) 361-0090
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
26812
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000050176
BLUE CROSS
KY
05
—
6426812100
—
KY
Enumeration date
05/12/2006
Last updated
10/05/2022
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