Healthcare Provider Details

I. General information

NPI: 1093876021
Provider Name (Legal Business Name): DANIEL E WHITNEY DPM PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4612 OUTER LOOP
LOUISVILLE KY
40219-3971
US

IV. Provider business mailing address

4612 OUTER LOOP
LOUISVILLE KY
40219-3971
US

V. Phone/Fax

Practice location:
  • Phone: 502-968-2233
  • Fax: 502-968-2283
Mailing address:
  • Phone: 502-968-2233
  • Fax: 502-968-2283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number00271
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00271
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number00271
License Number StateKY

VIII. Authorized Official

Name: MRS. GAIL K WHITNEY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 502-968-2233