Healthcare Provider Details

I. General information

NPI: 1629215058
Provider Name (Legal Business Name): KENTUCKY FOOT PROFESSIONALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 NICHOLASVILLE RD SUITE 1
LEXINGTON KY
40503-2520
US

IV. Provider business mailing address

2130 NICHOLASVILLE RD SUITE 1
LEXINGTON KY
40503-2520
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-7313
  • Fax: 859-260-1007
Mailing address:
  • Phone: 859-278-7313
  • Fax: 859-260-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY MOSHLUK
Title or Position: OFFICE MANAGER
Credential:
Phone: 859-278-7313