Individual
MARK A SEVERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6420 DUTCHMANS PKWY, 380, LOUISVILLE, KY 40205-3372
(502) 894-8441
(502) 894-4453
Mailing address
401 E CHESTNUT ST UNIT 170, LOUISVILLE, KY 40202-5701
(502) 583-3687
(502) 588-7840
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
01049174
IN
207Y00000X
Otolaryngology Physician
Primary
34466
KY
207YX0901X
Otology & Neurotology Physician
01049174
IN
207YX0901X
Otology & Neurotology Physician
34466
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000045447
ANTHEM FACET NUMBER
KY
01
—
040012436
RAIL ROAD MEDICARE
KY
05
—
200175990A
—
IN
05
—
64344666
—
KY
Enumeration date
07/07/2005
Last updated
10/10/2025
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