Provider Demographics
NPI:1336135995
Name:HERBSTRITH, AMI L (DPM)
Entity Type:Individual
Prefix:DR
First Name:AMI
Middle Name:L
Last Name:HERBSTRITH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8055 CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-5967
Mailing Address - Country:US
Mailing Address - Phone:901-309-7700
Mailing Address - Fax:901-507-3297
Practice Address - Street 1:8055 CLUB PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5967
Practice Address - Country:US
Practice Address - Phone:901-309-7700
Practice Address - Fax:901-507-3297
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN701213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I480399Medicaid
TNU90633Medicare UPIN