Individual
DR. MAURINE WATERHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4001 KRESGE WAY, SUITE 320, LOUISVILLE, KY 40207-4640
(502) 895-5850
Mailing address
4001 KRESGE WAY, SUITE 320, LOUISVILLE, KY 40207-4640
(502) 895-5850
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
29987
KY
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
29987
KY
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
29987
KY
2086S0105X
Surgery of the Hand (Surgery) Physician
29987
KY
2086S0122X
Plastic and Reconstructive Surgery Physician
29987
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000048443
BLUE CROSS
KY
01
—
1051840
PASSPORT
KY
01
—
4330141
AETNA
KY
05
—
64299878
—
KY
Enumeration date
01/23/2007
Last updated
01/11/2008
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