Provider Demographics
NPI:1104881994
Name:JORRISCH, MARK S (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:JORRISCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:STE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-899-4177
Mailing Address - Fax:502-259-6900
Practice Address - Street 1:3920 DUTCHMANS LN
Practice Address - Street 2:SUITE 315
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4702
Practice Address - Country:US
Practice Address - Phone:502-899-4177
Practice Address - Fax:502-259-6900
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2013-08-16
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Provider Licenses
StateLicense IDTaxonomies
KY20691207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64206915Medicaid
KY64206915Medicaid
KY00546135Medicare Oscar/Certification
KYP00427441Medicare PIN