1821294042 NPI number — CHERYL I DENZIK NP

Table of content: CHERYL I DENZIK NP (NPI 1821294042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821294042 NPI number — CHERYL I DENZIK NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENZIK
Provider First Name:
CHERYL
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821294042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3430 NEWBURG RD STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40218-2458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-454-8800
Provider Business Mailing Address Fax Number:
502-736-0140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3430 NEWBURG RD
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40218-2497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-454-8800
Provider Business Practice Location Address Fax Number:
502-736-0140
Provider Enumeration Date:
06/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SP0809X , with the licence number:  3002586 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X , with the licence number: 1064209 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 78007242 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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