Provider Demographics
NPI:1356411508
Name:NUNAMAKER, JACOB LAWRENCE IV (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:LAWRENCE
Last Name:NUNAMAKER
Suffix:IV
Gender:M
Credentials:MD
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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:STE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-821-8300
Practice Address - Fax:502-891-8338
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2019-10-17
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Provider Licenses
StateLicense IDTaxonomies
KY43177207RI0011X
KYTP888207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100107670Medicaid
KY000000693030OtherANTHEM- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY000057080NOtherHUMANA- CARDIOTHORACIC SURGERY OF LOUISVILLE
KYP00992197OtherRAILROAD MEDICARE
KYP00992197OtherRAILROAD MEDICARE
KY7100107670Medicaid