Provider Demographics
NPI:1295027126
Name:STICH, JEREMY PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:PATRICK
Last Name:STICH
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 1:3028 SHADY KNOLL RST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8952
Mailing Address - Country:US
Mailing Address - Phone:859-333-3065
Mailing Address - Fax:
Practice Address - Street 1:535 WELLINGTON WAY STE 330
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1331
Practice Address - Country:US
Practice Address - Phone:859-439-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44491207P00000X
KYTP715207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine