MEDICARE: AMANDA L DENZIK DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	07001180A	IN
2	213ES0103X	Foot & Ankle Surgery Podiatrist	243983	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P01370863	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50071771	OTHER	KY	PASSPORT HEALTH PLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000000880754	OTHER	KY	ANTHEM

General Provider Information

NPI Number	:	1124316195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA L DENZIK DPM

Provider Business Mailing Address
First Line	:	4612 OUTER LOOP
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40219-3971
Country	:	US
Telephone Number	:	502-804-4811
Fax Number	:

Provider Business Practice Location Address
First Line	:	4612 OUTER LOOP
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40219-3971
Country	:	US
Telephone Number	:	502-968-2233
Fax Number	:	502-968-2283

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2011
Last Update Date	:	07/15/2021

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Directions to “ AMANDA L DENZIK DPM” Practice Location

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