Provider Demographics
NPI:1275609539
Name:ASUMENDI, MIREN DENCIE (DO)
Entity Type:Individual
Prefix:DR
First Name:MIREN
Middle Name:DENCIE
Last Name:ASUMENDI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CHEROKEE RD STE 9
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1270
Mailing Address - Country:US
Mailing Address - Phone:502-458-6507
Mailing Address - Fax:
Practice Address - Street 1:1000 CHEROKEE RD STE 9
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1270
Practice Address - Country:US
Practice Address - Phone:502-458-6507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY025002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64025000Medicaid
KY64025000Medicaid
KY166516Medicare UPIN