Provider Demographics
NPI:1588791719
Name:KRESTIK, PAUL KARL (DPM)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KARL
Last Name:KRESTIK
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:1105 W 5TH ST
Mailing Address - Street 2:#3
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1610
Mailing Address - Country:US
Mailing Address - Phone:606-862-9900
Mailing Address - Fax:606-862-8901
Practice Address - Street 1:1105 W 5TH ST
Practice Address - Street 2:#3
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1610
Practice Address - Country:US
Practice Address - Phone:606-862-9900
Practice Address - Fax:606-862-8901
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2014-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY264213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80000128Medicaid
KY4586160001Medicare NSC
KY80000128Medicaid
KYU83859Medicare UPIN