Provider Demographics
NPI:1144270463
Name:RUMISEK, JOHN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:RUMISEK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:250 E LIBERTY ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1538
Mailing Address - Country:US
Mailing Address - Phone:502-584-2872
Mailing Address - Fax:502-587-0606
Practice Address - Street 1:250 E LIBERTY ST
Practice Address - Street 2:SUITE 900
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1538
Practice Address - Country:US
Practice Address - Phone:502-584-2872
Practice Address - Fax:502-587-0606
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2019-05-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY40066208G00000X
KYTP442208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64124365Medicaid