MEDICARE: MIKI WATANABE DUKE

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
1	106H00000X	Marriage & Family Therapist	105757	KY

General Provider Information

NPI Number	:	1033309331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKI WATANABE DUKE

Provider Business Mailing Address
First Line	:	8300 WESTPORT RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40242-3042
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 WESTPORT RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40242-3042
Country	:	US
Telephone Number	:	502-889-5533
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	12/12/2025

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