Provider Demographics
NPI:1124093075
Name:RENCO, HARRY L (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:L
Last Name:RENCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9517 US HIGHWAY 42 STE 410
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9237
Mailing Address - Country:US
Mailing Address - Phone:502-587-0521
Mailing Address - Fax:502-587-3890
Practice Address - Street 1:9517 US HIGHWAY 42 STE 410
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-9237
Practice Address - Country:US
Practice Address - Phone:502-587-0521
Practice Address - Fax:502-587-3890
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY32253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64322530Medicaid
KY64322530Medicaid
KY0782Medicare PIN
KY3883Medicare PIN
KY110153427Medicare PIN
KYF19709Medicare UPIN