MEDICARE: DR. ANDREW M DONOVAN 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	208000000X	Pediatrics Physician	01047227A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	351708493	OTHER	IN	TAX ID#
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568458586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW M DONOVAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 776879
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6879
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:	502-272-5116

Provider Business Practice Location Address
First Line	:	13328 SHELBYVILLE RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-3936
Country	:	US
Telephone Number	:	502-254-2223
Fax Number	:	502-254-2525

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	04/24/2024

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Directions to “ DR. ANDREW M DONOVAN M.D.” Practice Location

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