Provider Demographics
NPI:1063611952
Name:DIDYK, ANGELA BINNS (DPM)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:BINNS
Last Name:DIDYK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:BINNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:13105 EASTPOINT PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223
Mailing Address - Country:US
Mailing Address - Phone:502-426-4228
Mailing Address - Fax:502-426-4420
Practice Address - Street 1:13105 EASTPOINT PARK BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223
Practice Address - Country:US
Practice Address - Phone:502-426-4228
Practice Address - Fax:502-426-4420
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY348213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6337270001OtherPTAN