Individual
DR. MARK W DISTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 MIDDLETOWN PARK PL, SUITE C, LOUISVILLE, KY 40243-2515
(502) 244-9858
(502) 244-9575
Mailing address
301 MIDDLETOWN PARK PL, SUITE C, LOUISVILLE, KY 40243-2515
(502) 244-9858
(502) 244-9575
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
1042652
IN
208000000X
Pediatrics Physician
Primary
28797
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100373990
—
IN
Enumeration date
08/30/2006
Last updated
03/12/2014
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