Healthcare Provider Details

I. General information

NPI: 1497752612
Provider Name (Legal Business Name): ROBERT G MCHENDRIX III D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3126 DIXIE HWY SUITE 10
ERLANGER KY
41018-1866
US

IV. Provider business mailing address

3126 DIXIE HWY
ERLANGER KY
41018-1866
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-4777
  • Fax: 859-341-3133
Mailing address:
  • Phone: 859-331-4777
  • Fax: 859-341-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberK0125
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberK0125
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00125
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberK0125
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number00125
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: