Provider Demographics
NPI:1538378930
Name:LOUISVILLE FOOT AND ANKLE ASSOCIATES, PLLC
Entity type:Organization
Organization Name:LOUISVILLE FOOT AND ANKLE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:B
Authorized Official - Last Name:WIETING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:502-897-7770
Mailing Address - Street 1:3991 DUTCHMANS LN
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4700
Mailing Address - Country:US
Mailing Address - Phone:502-897-7770
Mailing Address - Fax:502-897-7776
Practice Address - Street 1:3991 DUTCHMANS LN
Practice Address - Street 2:SUITE 303
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4700
Practice Address - Country:US
Practice Address - Phone:502-897-7770
Practice Address - Fax:502-897-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYW00253213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80002520Medicaid
KY80002538Medicaid
KY090641Medicare ID - Type Unspecified
KY0906402Medicare ID - Type Unspecified
KYU76865Medicare UPIN
KYU77106Medicare UPIN
KY80002538Medicaid