MEDICARE: BRIAN A DEPREST M.D.

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
1	207Q00000X	Family Medicine Physician	32078	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00176786	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1049449	OTHER	PASSPORT / NMA
2	000052155P	OTHER	HUMANA / NMA
3	000000350656	OTHER	ANTHEM / NMA
4	009856	OTHER	SIHO / NMA
6	1193589	OTHER	CHA / NMA
7	2432515000	OTHER	PASSPORT ADVANTAGE / NMA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	1223284004	OTHER	CIGNA / NMA

General Provider Information

NPI Number	:	1184689861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN A DEPREST M.D.

Provider Business Mailing Address
First Line	:	PO BOX 776351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6351
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:	502-272-5116

Provider Business Practice Location Address
First Line	:	4420 DIXIE HWY
Second Line	:	STE. 114
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-2986
Country	:	US
Telephone Number	:	502-449-6464
Fax Number	:	502-449-6465

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	04/26/2023

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Directions to “ BRIAN A DEPREST M.D.” Practice Location

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