Healthcare Provider Details

I. General information

NPI: 1508065608
Provider Name (Legal Business Name): DERBY CITY FOOT DOCTORS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 SHELBYVILLE RD STE 11A
LOUISVILLE KY
40223-2965
US

IV. Provider business mailing address

9900 SHELBYVILLE RD STE 11A
LOUISVILLE KY
40223-2965
US

V. Phone/Fax

Practice location:
  • Phone: 502-899-9771
  • Fax: 502-899-9772
Mailing address:
  • Phone: 502-899-9771
  • Fax: 502-899-9772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00296
License Number StateKY

VIII. Authorized Official

Name: MISS RHONDA ANN EICHENBERGER
Title or Position: OWNER/MANAGER
Credential: DPM
Phone: 502-899-9771