Individual
KEVIN R GOETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 301-8074
(859) 301-4945
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 301-8074
(859) 301-4945
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
40586
KY
207R00000X
Internal Medicine Physician
40586
KY
208M00000X
Hospitalist Physician
01086731A
IN
208M00000X
Hospitalist Physician
Primary
40586
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2720596
—
OH
05
—
7100018590
—
KY
Enumeration date
04/19/2006
Last updated
03/17/2022
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