Provider Demographics
NPI:1538126354
Name:EHRHARDT, HEIDI M
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:EHRHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UK-DIV GENERAL INTERNAL MEDICINE
Mailing Address - Street 2:830 S. LIMESTONE, 3TH FL
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-323-0303
Mailing Address - Fax:859-323-1200
Practice Address - Street 1:UK-DIV GENERAL INTERNAL MEDICINE
Practice Address - Street 2:830 S. LIMESTONE, 3TH FL
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-0303
Practice Address - Fax:859-323-1200
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48489207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200493620Medicaid
IN069860UUMedicare PIN
IN3937240024OtherMEDICARE DMEPOS
ING84595Medicare UPIN
INP00323505OtherRAILROAD MEDICARE
IN715530X2Medicare ID - Type Unspecified
IN000000477547OtherANTHEM