Provider Demographics
NPI:1033103973
Name:RADEMAKER, JOHN BYRNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BYRNE
Last Name:RADEMAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0328
Mailing Address - Fax:
Practice Address - Street 1:3920 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4702
Practice Address - Country:US
Practice Address - Phone:502-259-6710
Practice Address - Fax:502-259-6704
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046769207L00000X
KY26478207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000064679OtherANTHEM OF INDIANA
IN000000064679OtherHEALTHLINK
IN000000064679OtherONE NATION BENEFIT
KY000000064679OtherANTHEM OF KENTUCKY
IN000000064679OtherINDIANA COMPREHENSIVE
IN129703800OtherBLACK LUNG PROGRAM
IN000000064679OtherUNICARE
IN134960BOtherUNICARE MEDICARE
IN200024520Medicaid
IN2439494000OtherPASSPORT ADVANTAGE
KY64264781Medicaid
IN129703800OtherUS DEPT OF LABOR
IN200024520OtherMANAGED HEALTH SERVICES
IN050067688OtherRAILROAD MEDICARE
KY1161027OtherPASSPORT
IN200024520OtherMDWISE HOOSIER ALLIANCE
IN000000064679OtherANTHEM MEDICAID
IN000000064679OtherANTHEM SENION ADVANTAGE
IN129703800OtherUS DEPT OF LABOR
IN000000064679OtherANTHEM MEDICAID