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NPI Code Detail

MEDICARE: MARK NICHOLAS FLESHMAN

MEDICARE: MARK NICHOLAS FLESHMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1225673635
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK NICHOLAS FLESHMAN
Provider Business Mailing Address
First Line : 158 STATE ST APT 2
Second Line :
City : LOUISVILLE
State : KY
Zip : 40206-3104
Country : US
Telephone Number : 606-585-4814
Fax Number :
Provider Business Practice Location Address
First Line : 5115 S 3RD ST
Second Line :
City : LOUISVILLE
State : KY
Zip : 40214-2601
Country : US
Telephone Number : 502-233-3030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2019
Last Update Date : 11/08/2019

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