Provider Demographics
NPI:1265454474
Name:ACKERMANN, DOUGLAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:M
Last Name:ACKERMANN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1169 EASTERN PKWY
Mailing Address - Street 2:SUITE G 71
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1417
Mailing Address - Country:US
Mailing Address - Phone:502-458-8661
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1818
Practice Address - Country:US
Practice Address - Phone:502-587-4330
Practice Address - Fax:502-587-4161
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-09-12
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Provider Licenses
StateLicense IDTaxonomies
KY22257207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0956501OtherCIGNA HEALTHCARE
220033467OtherRAILROAD MEDICARE
WV0199463000Medicaid
KY64222573Medicaid
KY1169937OtherPASSPORT MEDICAID
KY000000253063OtherANTHEM BLUE CROSS BS
1100338OtherUNITED HEALTHCARE
IN200031050AMedicaid
0956501OtherCIGNA HEALTHCARE
WV0199463000Medicaid