Provider Demographics
NPI:1346204526
Name:KOTHEIMER, ANITA ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:ROSE
Last Name:KOTHEIMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-489-5730
Mailing Address - Fax:502-489-5753
Practice Address - Street 1:140 STONECREST RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8142
Practice Address - Country:US
Practice Address - Phone:502-633-0094
Practice Address - Fax:502-633-0033
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21295207VX0000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64212954Medicaid
KYC14399Medicare UPIN
KYC14399Medicare UPIN