Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 01063119A | IN |
N | 111NI0900X | Internist | 01063119A | IN |
N | 207R00000X | Internist | 41010 | KY |
N | 111NI0900X | Internist | 41010 | KY |
N | 207RC0200X | Critical Care Medicine | 41010 | KY |
Y | 207RP1001X | Pulmonary Disease | 41010 | KY |
NPI | 1003954876 |
---|---|
Provider Name | Dr. Mark Edwin Esterle |
First Address | Louisville, KY 40207-4652 |
Second Address | Louisville, KY 40207-4652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 05/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000558682 | ANTHEM (01) | KY |