Provider Demographics
NPI:1689846677
Name:MCCORMACK, MORTON PATRICK
Entity Type:Individual
Prefix:
First Name:MORTON
Middle Name:PATRICK
Last Name:MCCORMACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 ZORN AVE
Mailing Address - Street 2:#39
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-3501
Mailing Address - Country:US
Mailing Address - Phone:502-742-2437
Mailing Address - Fax:
Practice Address - Street 1:750 ZORN AVE
Practice Address - Street 2:#39
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-3501
Practice Address - Country:US
Practice Address - Phone:502-742-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program