Provider Demographics
NPI:1811331390
Name:VETTER, MONICA HAGAN (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:HAGAN
Last Name:VETTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:SUZANNE
Other - Last Name:HAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776347
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6347
Mailing Address - Country:US
Mailing Address - Phone:502-559-9378
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:3991 DUTCHMANS LN STE 405
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4723
Practice Address - Country:US
Practice Address - Phone:502-899-3366
Practice Address - Fax:502-899-6686
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53729207V00000X, 207VX0201X
OH57.023268207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300083081Medicaid
KY7100665090Medicaid
KYK0003675OtherMEDICARE