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General NPI Number Information
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NPI Number | 1568436251
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Entity Type | Individual
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Provider Name | KENNETH R JAEGERS SR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4121 DUTCHMANS LN SUITE 410
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City | LOUISVILLE
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State | KY
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Zip | 40207-4707
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Country | US
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Telephone | 502-897-9881
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Fax | 502-897-9824
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Provider Business Mailing Address
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Address Line | 2 RIVER HILL RD
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City | LOUISVILLE
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State | KY
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Zip | 40207-1191
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Country | US
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Telephone | 502-896-1919
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 13244
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License Number State | KY
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