Individual
THERESA R KOESTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2900 CHANCELLOR DR, CRESTVIEW HILLS, KY 41017-5427
(859) 363-2142
(859) 363-2140
Mailing address
2900 CHANCELLOR DR, CRESTVIEW HILLS, KY 41017-5427
(859) 363-2142
(859) 363-2140
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
27960
KY
207R00000X
Internal Medicine Physician
Primary
27960
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000479137
ANTHEM
—
05
—
200944760
—
IN
01
—
310674100
FEDERAL BLACK LUNG
—
01
—
4296182
AETNA
—
01
—
50013712
PASSPORT
—
05
—
64279607
—
KY
Enumeration date
05/05/2006
Last updated
08/25/2009
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