Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 40066 | KY |
N | 208G00000X | Cardiothoracic Vascular Surgeon | TP442 | KY |
NPI | 1144270463 |
---|---|
Provider Name | Dr. John David Rumisek |
First Address | Louisville, KY 40202-1538 |
Second Address | Louisville, KY 40202-1538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 06/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64124365 | (05) | KY |
D51042 | (02) |