Individual
MATTHEW J FARGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
210 E GRAY ST, SUITE 700, LOUISVILLE, KY 40202-3900
(502) 629-5400
(502) 629-5492
Mailing address
PO BOX 766351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
26382
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000388725
ANTHEM - NMA
—
01
—
072303
SIHO - NMA
—
05
—
200520630
—
IN
01
—
2742795000
PAD - NMA
—
01
—
50011338
PASSPORT - NMA
—
01
—
50023117
PASSPORT- NORTON INPATIENT SPECIALISTS
KY
05
—
64263825
—
KY
01
—
6598354
CIGNA / NMA
—
01
—
P00299457
RRMCR - NMA
KY
Enumeration date
11/03/2005
Last updated
07/21/2016
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