Provider Demographics
NPI:1639181779
Name:VERMEESCH, MARILYN K (MD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:K
Last Name:VERMEESCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-253-4900
Mailing Address - Fax:502-489-5750
Practice Address - Street 1:107 MERIDIAN WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2878
Practice Address - Country:US
Practice Address - Phone:859-624-6366
Practice Address - Fax:859-624-6367
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2016-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY45650207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100173870Medicaid
KYK074452Medicare PIN