1982689949 NPI number — DR. BRIAN PRZYSTAWSKI DPM, PSC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982689949 NPI number — DR. BRIAN PRZYSTAWSKI DPM, PSC

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PRZYSTAWSKI

Provider First Name:

BRIAN

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

DPM, PSC

Provider Gender Code:

M

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:

1982689949

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/15/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 909

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:

40201-0909

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

502-588-0328

Provider Business Mailing Address Fax Number:

502-454-4235

Provider First Line Business Practice Location Address:

4119 BROWNS LN

Provider Second Line Business Practice Location Address:

BLDG 2

Provider Business Practice Location Address City Name:

LOUISVILLE

Provider Business Practice Location Address State Name:

KY

Provider Business Practice Location Address Postal Code:

40220-1500

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

502-454-4187

Provider Business Practice Location Address Fax Number:

502-454-4235

Provider Enumeration Date:

12/13/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 213ES0103X , with the licence number:  07000635 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 213ES0103X , with the licence number: 195 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 000000051908 . This is a "IN COMPREHENSIVE" identifier . This identifiers is of the category "OTHER".
• Identifier: 480027403 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 611327502 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
• Identifier: 9209 . This is a "MEDICARE GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 611327502 . This is a "TRICARE NORTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 000000051908 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 1054641 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: 000000051908 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 2433700000 . This is a "PASSPORT ADVANTAGE" identifier . This identifiers is of the category "OTHER".
• Identifier: 80001951 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: 000000051908 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
• Identifier: 215680 . This is a "MEDICARE GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".