MEDICARE: LEXINGTON MEDICAL GROUP CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1245728054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEXINGTON MEDICAL GROUP CORP

Provider Business Mailing Address
First Line	:	2276 BARNWELL LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1245
Country	:	US
Telephone Number	:	606-422-1456
Fax Number	:

Provider Business Practice Location Address
First Line	:	2276 BARNWELL LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1245
Country	:	US
Telephone Number	:	606-422-1456
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GHASSAN SHAKHASHIRO
Credential	:	MD
Telephone Number	:	606-422-1456

Provider Enumeration Date	:	04/26/2018
Last Update Date	:	04/26/2018

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Directions to “LEXINGTON MEDICAL GROUP CORP ” Practice Location

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