Provider Demographics
NPI:1902879836
Name:DEFOOR, CATHERINE A (MD)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:A
Last Name:DEFOOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-212-5025
Mailing Address - Fax:859-212-4432
Practice Address - Street 1:7370 TURFWAY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4895
Practice Address - Country:US
Practice Address - Phone:859-212-5025
Practice Address - Fax:859-212-4432
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079403D208000000X
KY36455208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64035819Medicaid
OH0052768Medicaid
KY50024405OtherPASSPORT MEDICAID
KYK011610Medicare PIN