Healthcare Provider Details

I. General information

NPI: 1205387263
Provider Name (Legal Business Name): GIAIMO MOBILE PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 PADGETT DR
CLINTON KY
42031-1313
US

IV. Provider business mailing address

12910 SHELBYVILLE RD SUITE 300
LOUISVILLE KY
40243-1593
US

V. Phone/Fax

Practice location:
  • Phone: 855-259-9183
  • Fax:
Mailing address:
  • Phone: 502-244-2441
  • Fax: 502-254-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00375
License Number StateKY

VIII. Authorized Official

Name: SCOTT GIAIMO
Title or Position: OWNER
Credential: DPM
Phone: 502-244-2441