Provider Demographics
NPI:1699803270
Name:GERARDO ULFE
Entity type:Organization
Organization Name:GERARDO ULFE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ULFE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:502-543-4100
Mailing Address - Street 1:317B GUTHRIE GRN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-543-4100
Mailing Address - Fax:502-543-4100
Practice Address - Street 1:317B GUTHRIE GRN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-543-4100
Practice Address - Fax:502-543-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00219213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80002199Medicaid
KY000000500312OtherBCBS
KY000000500312OtherBCBS
KY80002199Medicaid
KY1148870001Medicare NSC