Provider Demographics
NPI:1013945088
Name:DONOVAN, JAMES P (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:DONOVAN
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 766351
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:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:6420 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 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:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31284207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64312846Medicaid
IN200374310FMedicaid
KY1141305OtherPASSPORT PIN
KY000000693032OtherANTHEM - NCVA
KY2438110000OtherPASSPORT ADVANTAGE PIN
KY000000196590OtherANTHEM PIN
KY060063720OtherRAILROAD MEDICARE PIN
KY50031381OtherPASSPORT
IN200374310AMedicaid
KYP00893012OtherRAILROAD MEDICARE - NCVA
KY000057080EOtherHUMANA - NCVA
IN200374310FMedicaid
KY060063717Medicare PIN
KYP400031701Medicare PIN
KY64312846Medicaid
KY060063720OtherRAILROAD MEDICARE PIN
KY0780802Medicare PIN
KY00059011Medicare PIN
KY0713003Medicare ID - Type Unspecified