Provider Demographics
NPI:1124083969
Name:RENNIRT, DIANE A (MD)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:A
Last Name:RENNIRT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:400 BLANKENBAKER PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1850
Mailing Address - Country:US
Mailing Address - Phone:502-713-0777
Mailing Address - Fax:502-713-0778
Practice Address - Street 1:400 BLANKENBAKER PKWY STE 201
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1850
Practice Address - Country:US
Practice Address - Phone:502-713-0777
Practice Address - Fax:502-713-0778
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35001207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64034200Medicaid
KY64034200Medicaid
KYH11217Medicare UPIN
KY00546095Medicare Oscar/Certification