Provider Demographics
NPI:1649300716
Name:ROUCHKA, JENNIFER TOBIAS (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:TOBIAS
Last Name:ROUCHKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FRANCES
Other - Middle Name:JENNIFER
Other - Last Name:TOBIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:313 SHORT RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2815
Mailing Address - Country:US
Mailing Address - Phone:502-896-2594
Mailing Address - Fax:
Practice Address - Street 1:550 S JACKSON ST
Practice Address - Street 2:ACB BUILDING SUITE 300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-852-7041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1050207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine