Provider Demographics
NPI:1295763225
Name:YERASIMIDES, JONATHAN GEORGE (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:GEORGE
Last Name:YERASIMIDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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 1:9880 ANGIES WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2851
Practice Address - Country:US
Practice Address - Phone:502-394-6341
Practice Address - Fax:502-394-6340
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY40103207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64124043Medicaid
IN200489030Medicaid
IN200489030Medicaid
KY64124043Medicaid
KYP00720668OtherRAILROAD MEDICARE- NORTON ORTHO TRAUMA CARE
KY7060816OtherAETNA / R G SHEA
H63371Medicare UPIN
IN200489030Medicaid
KY200489030OtherMEDICAID INDIANA- NORTON ORTHO TRAUMA CARE
KY2782074000OtherPASSPORT ADV/UNIV ORTHO A
KY2782063000OtherPASPORT ADVANTAGE / R G SHEA
KY000000502758OtherANTHEM / UNIV ORTHO ASSOC
KY200489030OtherMD WISE- NORTON ORTHO TRAUMA CARE
KY64124043Medicaid
KY000000484004OtherANTHEM / R G SHEA
KYP00405352OtherRAILROAD MEDICARE / R G SHEA
KY64124043OtherMEDICAID- NORTON ORTHO TRAUMA CARE
KY200489030OtherHEALTHY INDIANA PLAN- NORTON ORTHO TRAUMA CARE
KY50012737OtherPASSPORT / UNIV ORTHO ASS
KY50012738OtherPASSPORT / R G SHEA
KY50021574OtherPASSPORT- NORTON ORTHO TRAUMA CARE
KY1367909Medicare PIN