Provider Demographics
NPI:1568625903
Name:VALENTINO, JANINE A (DPM)
Entity Type:Individual
Prefix:DR
First Name:JANINE
Middle Name:A
Last Name:VALENTINO
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:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-0213
Mailing Address - Country:US
Mailing Address - Phone:502-303-2339
Mailing Address - Fax:502-647-2137
Practice Address - Street 1:9880 ANGIES WAY SUITE 110
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2943
Practice Address - Country:US
Practice Address - Phone:502-446-6160
Practice Address - Fax:502-446-6161
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00312213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100064950Medicaid
KY00312OtherPODIATRIC LICENSE
KYP00700816OtherRAIL ROAD MEDICARE INDIVIDUAL PTAN #
KYP00700816OtherRAIL ROAD MEDICARE INDIVIDUAL PTAN #
KY00765001Medicare PIN