Severtson, Mark A

Severtson, Mark A is an individual health care provider with primary practice located at 6420 Dutchmans Pkwy 380, Louisville KY 40205-3372. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Otolaryngology, Allopathic & Osteopathic Physicians / Otology & Neurotology. Allopathic & Osteopathic Physicians / Otolaryngology is his primary health care specialty. Severtson, Mark A can be contacted via phone (502) 894-8441.

Contact Information

Primary practice address
6420 Dutchmans Pkwy 380 Louisville KY 40205-3372
Phone: (502) 894-8441
Fax: (502) 894-4453
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 34466 Kentucky
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 01049174 Indiana
Allopathic & Osteopathic Physicians / Otology & Neurotology 207YX0901X 34466 Kentucky
Allopathic & Osteopathic Physicians / Otology & Neurotology 207YX0901X 01049174 Indiana

Profile Details

NPI number 1861499576
LBN Legal business name Severtson, Mark A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2005
Last updated Jan 12th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861499576 NPPES
Kentucky Other 000000045447 ANTHEM FACET NUMBER
Kentucky Other 040012436 ANTHEM FACET NUMBER
Kentucky MEDICAID 64344666 ANTHEM FACET NUMBER
Kentucky MEDICAID 200175990A ANTHEM FACET NUMBER

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