Provider Demographics
NPI:1366475568
Name:BOHLER, HENRY CABOT LODGE JR (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:CABOT LODGE
Last Name:BOHLER
Suffix:JR
Gender:M
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:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0329
Mailing Address - Fax:502-588-0326
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:SUITE 410
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-271-5999
Practice Address - Fax:502-271-5994
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38316207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200463200Medicaid
KY64924855Medicaid
KY50000609OtherPASSPORT SPECIALTY# - FOUNDATION
KY50011024OtherPASSPORT SPECIALITY - PSC
KY000000299974OtherANTHEM - FOUNDATION
KYE62905Medicare UPIN
KY50000720OtherPASSPORT PCP#-FOUNDATION
IN200463200Medicaid
KY0722507Medicare ID - Type UnspecifiedKENTUCKY MEDICARE (FOUND)
KY1275782Medicare ID - Type Unspecified