Basic Information
| Provider Information | |||||||||
| NPI: | 1144710443 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 351 HUNTERS RUN NW | ||||||||
| Address2: | |||||||||
| City: | EDMONTON | ||||||||
| State: | ALBERTA | ||||||||
| PostalCode: | T6R 2P1 | ||||||||
| CountryCode: | CA | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 AUDUBON PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026367111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2018 | ||||||||
| LastUpdateDate: | 07/14/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 00491 | KY | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.