Provider Demographics
NPI:1720016611
Name:KAMMERLING, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:KAMMERLING
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:502-891-8338
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24304207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000057080HOtherHUMANA - NCVA
IN100388630FMedicaid
KY000000044919OtherANTHM PIN
KY2433838000OtherPASSPORT ADVANTAGE PIN
KY000000693031OtherANTHEM - NCVA
IN100388630AMedicaid
KY1056114OtherPASSPORT PIN
KYP00889590OtherMEDICARE RR - NCVA
KY50031414OtherPASSPORT & PASSPORT ADVTG NCVA
KY64243041Medicaid
KYP00889590OtherMEDICARE RR - NCVA
KY060018534Medicare PIN
KY64243041Medicaid
KY1056114OtherPASSPORT PIN
IN100388630FMedicaid
IN100388630AMedicaid
KY00335002Medicare PIN
KY1271811Medicare ID - Type Unspecified
IN100388630AMedicaid
KY060018534Medicare PIN
KY00059004Medicare PIN
KYP400031670Medicare PIN