Provider Demographics
NPI:1629033402
Name:QUAYE, JOSHUA N (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:N
Last Name:QUAYE
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: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 1:7926 PRESTON HWY
Practice Address - Street 2:STE 208
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3848
Practice Address - Country:US
Practice Address - Phone:502-968-3010
Practice Address - Fax:502-968-0035
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37458208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000231222OtherANTHEM / NCMA
000023035BOtherHUMANA / NCMA
KY64052467Medicaid
INP00421531OtherRRMCR FOR ICC
1166637OtherPASSPORT / NCMA
2440065000OtherPASSPORT ADVANTAGE / NCMA
1197541OtherCHA / NCMA
IN200832700Medicaid
KY010066030OtherRRMCR FOR ICC
017190OtherSIHO / NCMA
KY110240090OtherRR MCR FOR NCMA
3170255001OtherCIGNA / NCMA
000000231222OtherANTHEM / NCMA
IN200832700Medicaid
INP00421531OtherRRMCR FOR ICC
KYH65568Medicare UPIN