Individual
MARK PAUL BAZANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3991 DUTCHMANS LN, SUITE 310, LOUISVILLE, KY 40207-4700
(502) 899-6782
(502) 899-6783
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
01071068A
IN
2084N0400X
Neurology Physician
Primary
45824
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000824411
ANTHEM
KY
05
—
7100245160
—
KY
Enumeration date
06/25/2008
Last updated
01/12/2021
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