Healthcare Provider Details

I. General information

NPI: 1811331390
Provider Name (Legal Business Name): MONICA HAGAN VETTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA SUZANNE HAGAN

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3991 DUTCHMANS LN STE 405
LOUISVILLE KY
40207-4723
US

IV. Provider business mailing address

PO BOX 776347
CHICAGO IL
60677-6347
US

V. Phone/Fax

Practice location:
  • Phone: 502-899-3366
  • Fax: 502-899-6686
Mailing address:
  • Phone: 502-559-9378
  • Fax: 502-272-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number53729
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number57.023268
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number53729
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: