Individual
DR. KEITH WELLINGTON MYRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
6400 DUTCHMANS PKWY, SUITE 215, LOUISVILLE, KY 40205-3340
(502) 721-8288
(502) 721-8792
Mailing address
6400 DUTCHMANS PKWY, SUITE 215, LOUISVILLE, KY 40205-3340
(502) 721-8288
(502) 721-8792
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
251
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000382017
BLUE PREFERRED (ANTHEM)
KY
05
—
201363620
—
IN
01
—
50007597
PASSPORT
KY
05
—
80000318
—
KY
Enumeration date
10/24/2005
Last updated
08/30/2016
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