Individual
MARY E. RADEMAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7926 PRESTON HWY STE 106, LOUISVILLE, KY 40219-3848
(502) 964-4357
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
26525
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000562677
ANTHEM - ICC
KY
01
—
00533035
MEDICARE - KY - ICC
KY
01
—
096007
SIHO
KY
01
—
P00629108
KY - RAILROAD - MCR
KY
Enumeration date
03/27/2008
Last updated
09/03/2021
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