Provider Demographics
NPI:1760481824
Name:JARVIS, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:JARVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:815 E PARRISH AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3222
Mailing Address - Country:US
Mailing Address - Phone:270-688-0900
Mailing Address - Fax:270-685-0050
Practice Address - Street 1:815 E PARRISH AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3222
Practice Address - Country:US
Practice Address - Phone:270-688-0900
Practice Address - Fax:270-685-0050
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY15139207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
060044957OtherRAILROAD MEDICARE
IN100033110AMedicaid
000000041803OtherANTHEM BCBS
KY64151392Medicaid
010435700OtherBLACK LUNG
1524493OtherUMWA
010435700OtherBLACK LUNG
1524493OtherUMWA