Basic Information
| Provider Information | |||||||||
| NPI: | 1235185489 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TIPTON & UNROE, PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6801 DIXIE HWY | ||||||||
| Address2: | SUITE 134 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402583913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024474500 | ||||||||
| FaxNumber: | 5024490108 | ||||||||
| Practice Location | |||||||||
| Address1: | 6801 DIXIE HWY | ||||||||
| Address2: | SUITE 134 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402583913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024474500 | ||||||||
| FaxNumber: | 5024490108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 12/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | UNROE | ||||||||
| AuthorizedOfficialFirstName: | BRADFORD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 5024474500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 00205 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 80903537 | 05 | KY | MEDICAID |