Provider Demographics
NPI:1578745923
Name:MARGARET K SPARKS
Entity Type:Organization
Organization Name:MARGARET K SPARKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:K
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-200-9874
Mailing Address - Street 1:PO BOX 19027
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40259-0027
Mailing Address - Country:US
Mailing Address - Phone:866-200-9874
Mailing Address - Fax:502-966-9175
Practice Address - Street 1:10302 BROOKRIDGE VILLAGE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-4475
Practice Address - Country:US
Practice Address - Phone:866-200-9874
Practice Address - Fax:502-966-9175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23102207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6018OtherKY MEDICARE GROUP NUMBER
KYDD5649OtherKY RAILROAD MEDICARE GRP