Healthcare Provider Details

I. General information

NPI: 1104716232
Provider Name (Legal Business Name): BENJAMIN ENK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 POPLAR LEVEL RD
LOUISVILLE KY
40217-1359
US

IV. Provider business mailing address

4320 CARA WAY
LOUISVILLE KY
40299-4095
US

V. Phone/Fax

Practice location:
  • Phone: 502-637-4712
  • Fax:
Mailing address:
  • Phone: 414-617-7997
  • Fax: 414-617-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number1689
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: