Provider Demographics
NPI:1104693175
Name:PEKRINS, TED DEON
Entity type:Individual
Prefix:
First Name:TED
Middle Name:DEON
Last Name:PEKRINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-3607
Mailing Address - Country:US
Mailing Address - Phone:502-935-9622
Mailing Address - Fax:
Practice Address - Street 1:1720 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-3607
Practice Address - Country:US
Practice Address - Phone:502-935-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator