MEDICARE: DR. BRIAN PRZYSTAWSKI DPM, PSC

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	07000635	IN
2	213ES0103X	Foot & Ankle Surgery Podiatrist	195	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	480027403	OTHER		RAILROAD MEDICARE
4	9209	OTHER	KY	MEDICARE GROUP
12	215680	OTHER	IN	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000051908	OTHER		IN COMPREHENSIVE
3	611327502	OTHER		HUMANA
5	611327502	OTHER		TRICARE NORTH
6	000000051908	OTHER		UNICARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	000000051908	OTHER	KY	ANTHEM
9	2433700000	OTHER		PASSPORT ADVANTAGE
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	000000051908	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1982689949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN PRZYSTAWSKI DPM, PSC

Provider Business Mailing Address
First Line	:	PO BOX 909
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40201-0909
Country	:	US
Telephone Number	:	502-588-0328
Fax Number	:	502-454-4235

Provider Business Practice Location Address
First Line	:	4119 BROWNS LN
Second Line	:	BLDG 2
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-1500
Country	:	US
Telephone Number	:	502-454-4187
Fax Number	:	502-454-4235

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	10/15/2024

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Directions to “ DR. BRIAN PRZYSTAWSKI DPM, PSC” Practice Location

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