Healthcare Provider Details

I. General information

NPI: 1932466166
Provider Name (Legal Business Name): EDWIN JAMES APENBRINCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W 14TH ST SUITE 100A
JEFFERSONVILLE IN
47130-3751
US

IV. Provider business mailing address

302 W 14TH ST SUITE 100A
JEFFERSONVILLE IN
47130-3751
US

V. Phone/Fax

Practice location:
  • Phone: 812-590-6157
  • Fax:
Mailing address:
  • Phone: 812-590-6157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number49058
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01076426A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: