Healthcare Provider Details

I. General information

NPI: 1871620047
Provider Name (Legal Business Name): KENTUCKENTUCKY FOOT & ANKLE ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD STEB295
LEXINGTON KY
40504-3751
US

IV. Provider business mailing address

1401 HARRODSBURG RD STEB295
LEXINGTON KY
40504-3751
US

V. Phone/Fax

Practice location:
  • Phone: 859-276-5349
  • Fax: 859-276-5340
Mailing address:
  • Phone: 859-276-5349
  • Fax: 859-276-5340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00253
License Number StateKY

VIII. Authorized Official

Name: DR. CHRISTOPHER B WIETING
Title or Position: PRESIDENT
Credential: DPM
Phone: 859-276-5349