Provider Demographics
NPI:1649250010
Name:MAUSER, ALAN KEITH (DPM)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:KEITH
Last Name:MAUSER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2665
Mailing Address - Country:US
Mailing Address - Phone:502-458-8989
Mailing Address - Fax:502-451-5439
Practice Address - Street 1:2525 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2665
Practice Address - Country:US
Practice Address - Phone:502-458-8989
Practice Address - Fax:502-451-5439
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY176213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000049285OtherANTHEM
IN200082600Medicaid
KY80001761Medicaid
KY1059382OtherPASSPORT HEALTH PLAN
INP01048197OtherRAILROAD MEDICARE
KY80001761Medicaid
INM400062639Medicare PIN
INM300058578Medicare PIN
INP01048197OtherRAILROAD MEDICARE
KYT54182Medicare UPIN