Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 39335 | KY |
N | 207YP0228X | Pediatric Otolaryngology | 39335 | KY |
NPI | 1134206881 |
---|---|
Provider Name | Dr. Michael Anthony Domet |
First Address | Fort Thomas, KY 41075-4107 |
Second Address | Fort Thomas, KY 41075-4107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 01/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000360827 | ANTHEM (01) | |
100015770 | (05) | IN |
1001418 | UNITED HEALTHCARE (01) | |
1060353 | IN MEDICAL LICENSE (01) | IN |
200512280 | (05) | IN |
2556541 | (05) | OH |
35086041 | OH MEDICAL LICENSE (01) | OH |
39335 | KY MEDICAL LICENSE (01) | KY |
64105901 | (05) | KY |
65917965 | (05) | KY |
701342 | (05) | OH |
7708656 | AETNA (01) | |
I27581 | (02) |