Provider Demographics
NPI:1629034574
Name:GIRDLER, RENEE V (MD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:V
Last Name:GIRDLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:VANNUCCI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:6411 VETERANS MEMORIAL PARKWAY
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014
Practice Address - Country:US
Practice Address - Phone:502-852-5205
Practice Address - Fax:502-852-5405
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27385207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64273857Medicaid
IN200489810Medicaid
KY0921011Medicare PIN
KY00852002Medicare PIN
KY0048446Medicare PIN
KY0601238Medicare PIN
KY127128Medicare PIN
KY0523935Medicare PIN
IN200489810Medicaid
KY0631241Medicare PIN