Provider Demographics
NPI:1063740249
Name:MONDAY, TARA (DO)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MONDAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2835 ROLLING GREEN CT
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-7886
Mailing Address - Country:US
Mailing Address - Phone:859-380-8332
Mailing Address - Fax:
Practice Address - Street 1:7370 TURFWAY RD
Practice Address - Street 2:SUITE 280
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4895
Practice Address - Country:US
Practice Address - Phone:859-212-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03485208000000X, 2080A0000X
OH34.010565208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100207600Medicaid