Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 46284 | KY |
NPI | 1235331984 |
---|---|
Provider Name | Kerry Kaye Mcgowan |
First Address | Chicago, IL 60677-6879 |
Second Address | Louisville, KY 40202-1713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 26/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201176390 | (05) | IN |
7100246520 | (05) | KY |