Provider Demographics
NPI:1467558379
Name:DENISE HARDY DPM INC
Entity Type:Organization
Organization Name:DENISE HARDY DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-638-1590
Mailing Address - Street 1:7541 LOVELLA
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117
Mailing Address - Country:US
Mailing Address - Phone:314-638-1590
Mailing Address - Fax:
Practice Address - Street 1:9815 MACKENZIE RD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123
Practice Address - Country:US
Practice Address - Phone:314-638-1590
Practice Address - Fax:314-638-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO113313OtherBLUE SHIELD
MO2700678OtherUHC
MO113313OtherBLUE SHIELD