Provider Demographics
NPI:1619986973
Name:PEPPAS, DENNIS S (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:S
Last Name:PEPPAS
Suffix:
Gender:M
Credentials:MD
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 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4123 DUTCHMAN'S LANE
Practice Address - Street 2:SUITE 102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5832
Practice Address - Country:US
Practice Address - Phone:502-559-1670
Practice Address - Fax:502-559-1679
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48025208800000X
TXM0861208800000X
KYTP152208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168822802Medicaid
TX168822801OtherCIDC
TX8L11105Medicare PIN
KYK185650Medicare PIN
TX278750YNG9Medicare PIN
TX168822802Medicaid