Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 31945 | KY |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 31945 | KY |
NPI | 1508808361 |
---|---|
Provider Name | Mina C Kalfas |
First Address | Cincinnati, OH 45263-5283 |
Second Address | Crestview Hills, KY 41017-3477 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 22/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0987357 | (05) | OH |
64319452 | (05) | KY |