Individual
DR. JACOB LAWRENCE NUNAMAKER IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6420 DUTCHMANS PKWY, STE 200, LOUISVILLE, KY 40205-3372
(502) 821-8300
(502) 891-8338
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
43177
KY
207RI0011X
Interventional Cardiology Physician
TP888
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000693030
ANTHEM- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY
01
—
000057080N
HUMANA- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY
05
—
7100107670
—
KY
01
—
P00992197
RAILROAD MEDICARE
KY
Enumeration date
11/08/2006
Last updated
10/17/2019
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