Provider Demographics
NPI:1114053584
Name:KENTUCKY FOOT & ANKLE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:KENTUCKY FOOT & ANKLE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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:859-276-5349
Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:STE B295
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1764
Mailing Address - Country:US
Mailing Address - Phone:859-276-5349
Mailing Address - Fax:859-276-5340
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:STE B295
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1764
Practice Address - Country:US
Practice Address - Phone:859-276-5349
Practice Address - Fax:859-276-5340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00253213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8090002000Medicaid
KY1325610001Medicare NSC
KY6369Medicare PIN