Healthcare Provider Details

I. General information

NPI: 1154589182
Provider Name (Legal Business Name): JENNIFER ELIZABETH THOMPSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER CERMAN MD

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E CHESTNUT ST # STREET1
LOUISVILLE KY
40202-1713
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-3440
  • Fax: 502-588-3441
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45995
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.120254
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: