Provider Demographics
NPI:1003810987
Name:INGWERSEN, CHARLOTTE KAY (MD)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:KAY
Last Name:INGWERSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-543-4119
Mailing Address - Fax:502-543-1462
Practice Address - Street 1:187 ADAM SHEPHERD PKWY STE 5
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7500
Practice Address - Country:US
Practice Address - Phone:502-543-4119
Practice Address - Fax:502-543-1462
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2018-03-21
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
KY32033207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64320336Medicaid
KYG86619Medicare UPIN
KYP01348429 (KOHMG) RRMedicare PIN
KYK143050 (KOHMG)Medicare PIN