Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 00223 | KY |
NPI | 1023017522 |
---|---|
Provider Name | Matthew Enzweiler |
First Address | Cincinnati, OH 45263-5283 |
Second Address | Southgate, KY 41071 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 06/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
80002231 | (05) | KY |
90290081 | (05) | KY |
U65932 | (02) | KY |