Facts
- Status
- A
- Credential
- MD
- Type
- Individual
- Enumeration date
- 2015-12-02
- Last updated
- 2026-09-23
Specialties
Licenses
- License OH
- 35134012
Location
- Practice location
- 1955 DIXIE HWY STE N
- City
- FT WRIGHT KY
- Postal code
- 410112792
- Phone
- 859-341-6255
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.