Distler, Mark W

Distler, Mark W is an individual health care provider with primary practice located at 301 Middletown Park Pl Suite C, Louisville KY 40243-2515. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Distler, Mark W can be contacted via phone (502) 244-9858.

Contact Information

Primary practice address
301 Middletown Park Pl Suite C Louisville KY 40243-2515
Phone: (502) 244-9858
Fax: (502) 244-9575
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 1042652 Indiana
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 28797 Kentucky

Profile Details

NPI number 1568572733
LBN Legal business name Distler, Mark W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 30th, 2006
Last updated Mar 12th, 2014 - about 12 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568572733 NPPES
Indiana MEDICAID 100373990

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