Individual
CHARLES MATTHEW KODNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7430 JEFFERSON BLVD STE 100, LOUISVILLE, KY 40219-6159
(502) 969-0975
(502) 969-0975
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33170
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200150360
—
IN
05
—
64331705
—
KY
Enumeration date
05/15/2006
Last updated
09/02/2021
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