Individual
DEANA M. MENIKOFF
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
220 ABRAHAM FLEXNER WAY, SUITE 500, LOUISVILLE, KY 40202-3826
(502) 584-3376
(502) 584-1385
Mailing address
220 ABRAHAM FLEXNER WAY, SUITE 500, LOUISVILLE, KY 40202-3826
(502) 584-3376
(502) 584-1385
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA551
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000190242
ANTHEM PROVIDER #
KY
01
—
1130973
PASSPORT
KY
01
—
2437660000
PASSPORT ADVANTAGE
KY
05
—
9500112900
—
KY
Enumeration date
02/13/2006
Last updated
07/09/2007
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