Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 21295 | KY |
N | 207VX0000X | Obstetrician | 21295 | KY |
NPI | 1346204526 |
---|---|
Provider Name | Dr. Anita Rose Kotheimer |
First Address | Louisville, KY 40295-0248 |
Second Address | Shelbyville, KY 40065-8142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 04/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64212954 | (05) | KY |
C14399 | (02) | KY |