| NPI | 1518486885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNESSA RENEE BLACKMUN Administrator 502-418-4809 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MO 2010035799) |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2017-09-18 |