Provider Demographics
NPI:1952363764
Name:AMBROZIAK, DONALD L (DPM)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:AMBROZIAK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:141 PROSPEROUS PL
Mailing Address - Street 2:SUITE 22A
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1854
Mailing Address - Country:US
Mailing Address - Phone:859-263-2230
Mailing Address - Fax:859-263-8641
Practice Address - Street 1:141 PROSPEROUS PL
Practice Address - Street 2:SUITE 22A
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1854
Practice Address - Country:US
Practice Address - Phone:859-263-2230
Practice Address - Fax:859-263-8641
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY00148213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80903784Medicaid
KY80001480Medicaid
KY80001480Medicaid
KY0297430001Medicare NSC
KY0001401Medicare PIN
KY0001402Medicare PIN