Basic Information
| Provider Information | |||||||||
| NPI: | 1942261250 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUATKEMEYER | ||||||||
| FirstName: | BRADFORD | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635283 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594281610 | ||||||||
| FaxNumber: | 8594283923 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 VIOLET RD | ||||||||
| Address2: | |||||||||
| City: | CRITTENDEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410308956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594281610 | ||||||||
| FaxNumber: | 8594283923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 09/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 32259 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64322597 | 05 | KY | MEDICAID | K252620 | 01 | KY | KY MEDICARE | OTHER | 2159104 | 01 | OH | MEDICAID | OTHER |