Provider Demographics
NPI:1346224284
Name:SPRINGER, MICHAEL JAY (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAY
Last Name:SPRINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-272-5573
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:6420 DUTCHMANS PKWY
Practice Address - Street 2:STE. 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-891-8300
Practice Address - Fax:502-891-8338
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26839207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY060037493OtherRAILROAD MEDICARE
KY1050377Medicaid
KY2432840000Medicaid
KY64268394Medicaid
KY060057267OtherRAILROAD MEDICARE
IN200040910Medicaid
KY00309008Medicare PIN
KY0690809Medicare PIN
IN126930MMedicare PIN
IN251440NMedicare PIN
KY00308008Medicare PIN
IN200040910Medicaid
KYP00612967Medicare PIN
KY00314008Medicare PIN
KY060037493OtherRAILROAD MEDICARE
IN228550MMedicare PIN
KY00313008Medicare PIN
KY00312008Medicare PIN
KY0245423Medicare PIN
KYA51453Medicare UPIN
KY1050377Medicaid
KY2432840000Medicaid
KY00311008Medicare PIN