Healthcare Provider Details

I. General information

NPI: 1669836268
Provider Name (Legal Business Name): ERINN AFFLICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2016
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E CHESTNUT ST
LOUISVILLE KY
40202-1831
US

IV. Provider business mailing address

4834 ROLLING GREEN DR
WESLEY CHAPEL FL
33543-7007
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-5552
  • Fax: 502-629-3132
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number57773
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number57773
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: