Individual
DR. MATTHEW TODD DESJARDINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
560 S LOOP RD, EDGEWOOD, KY 41017-3405
(859) 301-2663
(859) 301-0655
Mailing address
560 S LOOP RD, EDGEWOOD, KY 41017-3405
(859) 301-2663
(859) 301-0655
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
38980
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000333833
ANTHEM
KY
01
—
0428850004
MEDICARE DME
KY
05
—
64088594
—
KY
01
—
90008962
MEDICAID DME
KY
01
—
CB8861
RAILROAD MEDICARE
KY
01
—
P00156471
RAILROAD MEDICARE
KY
Enumeration date
06/01/2005
Last updated
05/11/2015
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