Healthcare Provider Details

I. General information

NPI: 1902879836
Provider Name (Legal Business Name): CATHERINE A DEFOOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 TURFWAY ROAD
FLORENCE KY
41042-4895
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-212-5025
  • Fax: 859-212-4432
Mailing address:
  • Phone: 859-212-5025
  • Fax: 859-212-4432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35079403D
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36455
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: