Healthcare Provider Details

I. General information

NPI: 1952566895
Provider Name (Legal Business Name): CHRISANTHY ZOWTIAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 SOUTH LOOP ROAD ST. ELIZABETH HEALTHCARE CENTER FOR FAMILY MEDICINE
EDGEWOOD KY
41017-5446
US

IV. Provider business mailing address

413 S LOOP RD
EDGEWOOD KY
41017-5446
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-3800
  • Fax: 859-301-3987
Mailing address:
  • Phone: 859-301-3800
  • Fax: 859-301-3820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLL17963
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTP002
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47655
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: