1689647042 NPI number — DR. RODNEY E KOSFELD M.D.

Table of content: DR. RODNEY E KOSFELD M.D. (NPI 1689647042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689647042 NPI number — DR. RODNEY E KOSFELD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOSFELD
Provider First Name:
RODNEY
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689647042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1930 BISHOP LN
Provider Second Line Business Mailing Address:
SUITE 1017
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40218-1921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-272-5754
Provider Business Mailing Address Fax Number:
502-272-5339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 E BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-629-2500
Provider Business Practice Location Address Fax Number:
502-629-2055
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0000X , with the licence number:  01036269A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0000X , with the licence number: 20643 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 64206436 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10007590A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 830005645 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10882909 . This is a "PASSPORT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000051750 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".




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