Provider Demographics
NPI:1225337934
Name:FENSTERER, TATHYANA MARQUES F (MD)
Entity Type:Individual
Prefix:MRS
First Name:TATHYANA
Middle Name:MARQUES F
Last Name:FENSTERER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2507 BUSH RIDGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5885
Mailing Address - Country:US
Mailing Address - Phone:502-589-8000
Mailing Address - Fax:502-589-8001
Practice Address - Street 1:2507 BUSH RIDGE DR STE B
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245
Practice Address - Country:US
Practice Address - Phone:502-589-8000
Practice Address - Fax:502-589-8001
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY521682086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty