Healthcare Provider Details

I. General information

NPI: 1205055332
Provider Name (Legal Business Name): ACHILLIES FOOT AND ANKLE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 B GUTHERIE GREEN
LOUISVILLE KY
40202
US

IV. Provider business mailing address

317 B GUTHERIE GREEN
LOUISVILLE KY
40202
US

V. Phone/Fax

Practice location:
  • Phone: 502-585-3668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00219
License Number StateKY

VIII. Authorized Official

Name: DR. GERARDO ULFE
Title or Position: OWNER
Credential: DPM
Phone: 502-585-3668