Individual
KEITH D FORWITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4004 DUPONT CIR, SUITE 220, LOUISVILLE, KY 40207-4819
(502) 893-0159
(502) 213-3853
Mailing address
PO BOX 950116, LOUISVILLE, KY 40295-0116
(502) 893-0159
(502) 213-3853
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
36650
KY
207Y00000X
Otolaryngology Physician
01054405A
IN
207Y00000X
Otolaryngology Physician
Primary
36650
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040015870
MEDICARE RR
KY
05
—
64959729
—
KY
Enumeration date
06/28/2005
Last updated
06/02/2014
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