Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 244105 | KY |
Y | 222Z00000X | Podiatrist | 244105 | KY |
NPI | 1013438746 |
---|---|
Provider Name | Andrew R Bouwkamp |
First Address | Louisville, KY 40202-2458 |
Second Address | Louisville, KY 40206-2459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2017 |
Last Update Date | 13/07/2020 |