Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0106X | Orthopaedic Hand Surgeon | 11014606A | IN |
N | 207XS0106X | Orthopaedic Hand Surgeon | FT428 | KY |
N | 2086S0105X | Surgery of the Hand | 11014606A | IN |
Y | 2086S0105X | Surgery of the Hand | FT428 | KY |
NPI | 1902053457 |
---|---|
Provider Name | Renato Botelho |
First Address | Louisville, KY 40202-1882 |
Second Address | Louisville, KY 40202-1882 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2008 |
Last Update Date | 26/08/2008 |