Provider Demographics
NPI:1487703195
Name:LAUSE', FRED V (DPM)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:V
Last Name:LAUSE'
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1107 INDIAN MOUND DR
Mailing Address - Street 2:STE C
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1300
Mailing Address - Country:US
Mailing Address - Phone:859-498-5151
Mailing Address - Fax:859-498-8668
Practice Address - Street 1:1107 INDIAN MOUND DR
Practice Address - Street 2:STE C
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1300
Practice Address - Country:US
Practice Address - Phone:859-498-5151
Practice Address - Fax:859-498-8668
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00225213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00225OtherSTATE LICENSE NUMBER
KY80002256Medicaid
KY00225OtherSTATE LICENSE NUMBER
KY2017201Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
KYU45079Medicare UPIN