Healthcare Provider Details

I. General information

NPI: 1124510367
Provider Name (Legal Business Name): ZACHARY KORNEFFEL-ROTTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ZACHARY ROTTER

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E CHESTNUT ST
LOUISVILLE KY
40202-1831
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-8000
  • Fax: 502-629-6129
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number62056
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: