Provider Demographics
NPI:1295827921
Name:ZWISCHENBERGER, JOSEPH B (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:B
Last Name:ZWISCHENBERGER
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 1:800 ROSE STREET, MN264
Mailing Address - Street 2:UNIVERSITY OF KENTUCKY, DEPARTMENT OF SURGERY
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0298
Mailing Address - Country:US
Mailing Address - Phone:859-323-6013
Mailing Address - Fax:859-323-1045
Practice Address - Street 1:800 ROSE STREET, MN264
Practice Address - Street 2:UNIVERSITY OF KENTUCKY, DEPARTMENT OF SURGERY
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0298
Practice Address - Country:US
Practice Address - Phone:859-323-6013
Practice Address - Fax:859-323-1045
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY413212086S0102X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129740002Medicaid
TX83330NMedicare ID - Type Unspecified
TX129740002Medicaid