Provider Demographics
NPI:1235192451
Name:DIMAR, JOHN R II (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:DIMAR
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:SUITE 900
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3900
Practice Address - Country:US
Practice Address - Phone:502-584-7525
Practice Address - Fax:502-589-0849
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY24311207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1049631OtherPASSPORT (UNIVERSITY ORTH
KY2432608000OtherPASSPORT ADVANTAGE (UNIVE
KY3728038000OtherPASSPORT ADVANTAGE- NORTON LEATHERMAN SPINE CENTER
KY64243116Medicaid
KYP00757242OtherRAILROAD MEDICARE- NORTON LEATHERMAN SPINE CENTER
KY1054521OtherPASSPORT (SPINE INSTITUTE
KY2433675000OtherPASSPORT ADVANTAGE (SPINE
KY000000049465OtherANTHEM (SPINE INSTITUTE)
IN100373930Medicaid
KY163722400OtherUS DEPT OF LABOR
KY000000049348OtherANTHEM (UNIVERSITY ORTHOP
KY50024962OtherPASSPORT- NORTON LEATHERMAN SPINE CENTER
INN291921OtherHARMONY
KY000051983LOtherHUMANA- NORTON LEATHERMAN SPINE CENTER
KY200007231OtherRAILROAD MEDICARE (SPINE
KY200031865OtherRAILROAD MEDICARE (UNIVER
KY1054521OtherPASSPORT (SPINE INSTITUTE
IN141460BMedicare PIN
KY163722400OtherUS DEPT OF LABOR
KYE74209Medicare UPIN
KY0605906Medicare PIN