Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 01043869A | IN |
Y | 207K00000X | Allergist & Immunologist | 28022 | KY |
NPI | 1215937693 |
---|---|
Provider Name | Timothy A Feger |
First Address | Louisville, KY 40223-2992 |
Second Address | Louisville, KY 40223-2992 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 15/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200036520 | (05) | IN |
50001588 | PASSPORT HEALTH PLAN (01) | |
64280225 | (05) | KY |
G06295 | (02) |