Provider Demographics
NPI:1093876021
Name:DANIEL E WHITNEY DPM PSC
Entity Type:Organization
Organization Name:DANIEL E WHITNEY DPM PSC
Other - Org Name:KENTUCKY FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-968-2233
Mailing Address - Street 1:4612 OUTER LOOP
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3971
Mailing Address - Country:US
Mailing Address - Phone:502-968-2233
Mailing Address - Fax:502-968-2283
Practice Address - Street 1:4612 OUTER LOOP
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3971
Practice Address - Country:US
Practice Address - Phone:502-968-2233
Practice Address - Fax:502-968-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00271213ES0103X, 213ES0131X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2433706000OtherPASSPORT ADVANTAGE
KYCC9003OtherRAILROAD MEDICARE
KY90004722Medicaid
KY1157245OtherDME PASSPORT
KY80903735Medicaid
KY80903495Medicaid
KY1054674OtherPASSPORT
KY=========OtherTRICARE
KYCC9003OtherRAILROAD MEDICARE
KY0003Medicare PIN
KY80903495Medicaid