Provider Demographics
NPI:1902835093
Name:DEGEARE, VINCENT S (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:S
Last Name:DEGEARE
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 1:6420 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-891-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37390207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200409360FMedicaid
KY64064769Medicaid
KY000000290251OtherANTHEM PIN
KS000000693043OtherANTHEM - NCVA
KY50001245OtherPASSPORT PIN
KYP00893038OtherRAILROAD MEDICARE - NCVA
KY000057080DOtherHUMANA - NCVA
IN200409360AMedicaid
KY2442856000OtherPASSPORT ADVANTAGE PIN
KY50001245OtherPASSPORT PIN
KY0558317Medicare ID - Type Unspecified
KY000000290251OtherANTHEM PIN
KY2442856000OtherPASSPORT ADVANTAGE PIN
KYP400031851Medicare PIN
KY0558214Medicare ID - Type Unspecified
KY060071315Medicare PIN
KYG80743Medicare UPIN
KY0558608Medicare ID - Type Unspecified
KY0368214Medicare ID - Type Unspecified
KY1271846Medicare ID - Type Unspecified
KY64064769Medicaid