Provider Demographics
NPI:1770506883
Name:MAURER, KATHLEEN J (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:MAURER
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 1:400 BLANKENBAKER PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1882
Mailing Address - Country:US
Mailing Address - Phone:502-244-6373
Mailing Address - Fax:502-244-9860
Practice Address - Street 1:400 BLANKENBAKER PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1882
Practice Address - Country:US
Practice Address - Phone:502-244-6373
Practice Address - Fax:502-244-9860
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24475208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64244759Medicaid
KY0527004Medicare ID - Type Unspecified
KY64244759Medicaid