Individual
DR. MICHAEL ANTHONY DOMET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
40 N GRAND AVE, SUITE 101, FORT THOMAS, KY 41075-4107
(859) 781-4900
(859) 572-3044
Mailing address
40 N GRAND AVE, SUITE 101, FORT THOMAS, KY 41075-4107
(859) 781-4900
(859) 572-3044
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
39335
KY
207YP0228X
Pediatric Otolaryngology Physician
39335
KY
207YX0602X
Otolaryngic Allergy Physician
39335
KY
207YX0901X
Otology & Neurotology Physician
39335
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000360827
ANTHEM
—
05
—
100015770
—
IN
01
—
1001418
UNITED HEALTHCARE
—
01
—
1060353
IN MEDICAL LICENSE
IN
05
—
200512280
—
IN
05
—
2556541
—
OH
01
—
35086041
OH MEDICAL LICENSE
OH
01
—
39335
KY MEDICAL LICENSE
KY
05
—
64105901
—
KY
05
—
65917965
—
KY
05
—
701342
—
OH
01
—
7708656
AETNA
—
Enumeration date
11/01/2006
Last updated
05/01/2018
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