Provider Demographics
NPI:1841364346
Name:PYATAK-HUGAR, KATHLEEN M (DPM)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:PYATAK-HUGAR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:PYATAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1905 W HEBRON LN STE 204
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-7467
Mailing Address - Country:US
Mailing Address - Phone:502-797-3338
Mailing Address - Fax:502-957-1731
Practice Address - Street 1:1905 W HEBRON LN STE 204
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7467
Practice Address - Country:US
Practice Address - Phone:502-797-3338
Practice Address - Fax:502-957-1731
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003494213ES0103X
NYN006183-1213ES0103X
KY00371213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT92556Medicare UPIN
KYP400030478Medicare PIN