Healthcare Provider Details

I. General information

NPI: 1679197131
Provider Name (Legal Business Name): HANS CARL HUMRICK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 GRANT LINE RD
NEW ALBANY IN
47150-2492
US

IV. Provider business mailing address

7397 JEFFERSON BLVD
LOUISVILLE KY
40219-6178
US

V. Phone/Fax

Practice location:
  • Phone: 812-725-7542
  • Fax: 812-725-7543
Mailing address:
  • Phone: 502-968-2233
  • Fax: 502-968-2283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number284787
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07001433A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number284787
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07001433A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: