Provider Demographics
NPI:1831984707
Name:ROBERTS, EAIN DONALD (DPM, MBA)
Entity type:Individual
Prefix:
First Name:EAIN
Middle Name:DONALD
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DPM, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4119 BROWNS LN # 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1500
Mailing Address - Country:US
Mailing Address - Phone:502-897-1616
Mailing Address - Fax:
Practice Address - Street 1:4119 BROWNS LN # 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1500
Practice Address - Country:US
Practice Address - Phone:502-897-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program