Healthcare Provider Details

I. General information

NPI: 1629034574
Provider Name (Legal Business Name): RENEE V GIRDLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE VANNUCCI

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6411 VETERANS MEMORIAL PKWY STE 100
CRESTWOOD KY
40014-8698
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-241-8611
  • Fax: 502-241-4175
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27385
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: