Provider Demographics
NPI:1497772255
Name:MARZIAN, JEFFREY KENNETH (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KENNETH
Last Name:MARZIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 GATECREEK RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-2687
Mailing Address - Country:US
Mailing Address - Phone:502-381-7563
Mailing Address - Fax:513-858-7827
Practice Address - Street 1:3403 GATECREEK RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-2687
Practice Address - Country:US
Practice Address - Phone:502-381-7563
Practice Address - Fax:513-858-7827
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00388213E00000X, 213E00000X
SD186213E00000X
NE299213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100216340Medicaid
IN201073770Medicaid
KYK073700Medicare PIN
KY7100216340Medicaid
IA475111Medicaid
SD6800700Medicaid
IA15819Medicare PIN
KYK073700Medicare PIN
IN201073770Medicaid
NE279703Medicare PIN