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NPI Code Detail

MEDICARE: CHARLES M BROHM MD

MEDICARE: CHARLES M BROHM MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician14421KY
2207L00000XAnesthesiology Physician01039758AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568462331
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES M BROHM MD
Provider Business Mailing Address
First Line : PO BOX 34748
Second Line :
City : LOUISVILLE
State : KY
Zip : 40232-4748
Country : US
Telephone Number : 502-259-5391
Fax Number : 502-259-9733
Provider Business Practice Location Address
First Line : 4000 KRESGE WAY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40207-4605
Country : US
Telephone Number : 502-259-5391
Fax Number : 502-259-9733
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2005
Last Update Date : 07/08/2007

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