Provider Demographics
NPI:1396724522
Name:BIDDLE, PAMELA C (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:C
Last Name:BIDDLE
Suffix:
Gender:F
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:502-559-9407
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:9217 US HIGHWAY 42 STE E
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-8854
Practice Address - Country:US
Practice Address - Phone:502-228-1312
Practice Address - Fax:502-228-5541
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31980208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64056658Medicaid
KY1169722OtherPASSPORT
KYG72982Medicare UPIN