Provider Demographics
NPI:1083805022
Name:SARKANICH, NATALIE L (MD FAAP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:L
Last Name:SARKANICH
Suffix:
Gender:F
Credentials:MD FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14610 LAKE BLUFF PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245
Mailing Address - Country:US
Mailing Address - Phone:502-245-6049
Mailing Address - Fax:
Practice Address - Street 1:14610 LAKE BLUFF PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5259
Practice Address - Country:US
Practice Address - Phone:502-245-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39076208000000X
NJ208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1371002Medicaid
D008611OtherCDS
AS0664018OtherDEA
D008611OtherCDS
NJSA3001903Medicare PIN