Provider Demographics
NPI:1063467660
Name:HAMILTON, DUSTIN T (MD)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:T
Last Name:HAMILTON
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 1:5454 NEW CUT RD
Mailing Address - Street 2:STE 5
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-4271
Mailing Address - Country:US
Mailing Address - Phone:502-361-9900
Mailing Address - Fax:502-955-3383
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2877
Practice Address - Country:US
Practice Address - Phone:502-587-4421
Practice Address - Fax:502-587-4840
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40403207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00000057678OtherANTHEM
KY2711347000OtherPASSPORT ADVANTAGE
KY64094238Medicaid
KYP00303970OtherRAILROAD MEDICARE
KY50010525OtherPASSPORT
IN200851120Medicaid
KY64094238Medicaid
I24633Medicare UPIN
KY2711347000OtherPASSPORT ADVANTAGE
IN200851120Medicaid