Provider Demographics
NPI:1831194638
Name:DUE, THOMAS MARK (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MARK
Last Name:DUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:560 S LOOP RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3405
Mailing Address - Country:US
Mailing Address - Phone:859-301-2663
Mailing Address - Fax:859-301-0655
Practice Address - Street 1:560 S LOOP RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3405
Practice Address - Country:US
Practice Address - Phone:859-301-2663
Practice Address - Fax:859-817-7848
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY24524207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64245244Medicaid
IN300030315Medicaid
KY90008962OtherMEDICAID DME
KY000000033983OtherANTHEM
KY200003946OtherRAILROAD MEDICARE
KY428850001OtherMEDICARE DME
C73887Medicare UPIN
KY90008962OtherMEDICAID DME