Individual
JEREMY L THORNEWILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4420 DIXIE HWY, STE. 114, LOUISVILLE, KY 40216-2986
(502) 449-6464
(502) 449-6465
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
37102
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000350636
ANTHEM / NMA
—
01
—
000052155
HUMANA / NMA
—
01
—
015654
SIHO / NMA
—
01
—
1167891
PASSPORT / NMA
—
01
—
1196970
CHA / NMA
—
05
—
200414770
—
IN
01
—
2440217000
PASSPORT ADVANTAGE / NMA
—
01
—
3094612001
CIGNA / NMA
—
05
—
64051808
—
KY
01
—
P00185976
RAILROAD MEDICARE
KY
Enumeration date
04/18/2006
Last updated
02/02/2017
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