Brockman, Mark
Brockman, Mark is an individual health care provider with primary practice located at 115 Huston Dr Ste 2 , Shepherdsville KY 40165-7250. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Brockman, Mark can be contacted via phone (502) 955-8979.Contact Information
Primary practice address
115 Huston Dr Ste 2
Shepherdsville KY 40165-7250
Phone: (502) 955-8979
Fax: (502) 955-1205
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 51074 | Kentucky |
Profile Details
| NPI number | 1568857795 |
|---|---|
| LBN Legal business name | Brockman, Mark |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 3rd, 2015 |
| Last updated | Sep 21st, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568857795 | NPPES |
| Kentucky | Other | K270741 | MEDICARE |
| Kentucky | MEDICAID | 300044581 | MEDICARE |
| Kentucky | MEDICAID | 7100435590 | MEDICARE |
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