Provider Demographics
NPI:1003954876
Name:ESTERLE, MARK EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWIN
Last Name:ESTERLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4003 KRESGE WAY
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4652
Mailing Address - Country:US
Mailing Address - Phone:502-899-7377
Mailing Address - Fax:502-899-1972
Practice Address - Street 1:4003 KRESGE WAY
Practice Address - Street 2:SUITE 312
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4652
Practice Address - Country:US
Practice Address - Phone:502-899-7377
Practice Address - Fax:502-899-1972
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2014-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01063119A207R00000X
KY41010207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000558682OtherANTHEM
KY000000558682OtherANTHEM
KYP00605793Medicare PIN