Provider Demographics
NPI:1194724997
Name:CHARIKER, MARK E (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:CHARIKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:E
Other - Last Name:CHARIKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:222 S 1ST ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1350
Mailing Address - Country:US
Mailing Address - Phone:502-568-4800
Mailing Address - Fax:502-589-6882
Practice Address - Street 1:222 S 1ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1350
Practice Address - Country:US
Practice Address - Phone:502-568-4800
Practice Address - Fax:502-589-6882
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY296072082S0099X, 2082S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64006828Medicaid
KY000000206969OtherANTHEM
IN200236700AMedicaid
KY000000206969OtherANTHEM
KYC60750Medicare UPIN