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General NPI Number Information
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NPI Number | 1861499576
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Entity Type | Individual
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Provider Name | MARK A SEVERTSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 6420 DUTCHMANS PKWY 380
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City | LOUISVILLE
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State | KY
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Zip | 40205-3372
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Country | US
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Telephone | 502-894-8441
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Fax | 502-894-4453
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Provider Business Mailing Address
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Address Line | 401 E CHESTNUT ST UNIT 170
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City | LOUISVILLE
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State | KY
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Zip | 40202-5701
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Country | US
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Telephone | 502-583-3687
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Fax | 502-588-7840
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 34466
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 01049174
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207YX0901X
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Taxonomy Name | Otology & Neurotology Physician
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License Number | 01049174
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207YX0901X
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Taxonomy Name | Otology & Neurotology Physician
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License Number | 34466
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License Number State | KY
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