Provider Demographics
NPI:1700894698
Name:RODES, VIVIAN S (DPM)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:S
Last Name:RODES
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 1:3080 HARRODSBURG RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2774
Mailing Address - Country:US
Mailing Address - Phone:859-296-4272
Mailing Address - Fax:859-296-9645
Practice Address - Street 1:3080 HARRODSBURG RD
Practice Address - Street 2:SUITE 225
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2774
Practice Address - Country:US
Practice Address - Phone:859-296-4272
Practice Address - Fax:859-296-9645
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00228213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY480031508OtherMEDICARE RAIL ROAD
2731875003OtherCIGNA
KY5223493OtherAETNA
KY000000067586OtherANTHEM BCBS
433808OtherTRIGON BCBS
2700062OtherUHC
KY80002280Medicaid
1525858OtherUMWA
KY0585301Medicare ID - Type Unspecified
KY80002280Medicaid