Provider Demographics
NPI:1114180221
Name:NIMTZ, JARED CHRISTIAN (MD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:CHRISTIAN
Last Name:NIMTZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:715 SHAKER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3662
Mailing Address - Country:US
Mailing Address - Phone:859-277-9435
Mailing Address - Fax:859-277-8852
Practice Address - Street 1:715 SHAKER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3662
Practice Address - Country:US
Practice Address - Phone:859-277-9435
Practice Address - Fax:859-277-8852
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2018-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY46515208200000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery