MEDICARE: DR. KASEY MICHELLE EIDSON M.D.

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	207Q00000X	Family Medicine Physician	R2530	KY
2	207Q00000X	Family Medicine Physician	47495	KY

General Provider Information

NPI Number	:	1437312311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KASEY MICHELLE EIDSON M.D.

Provider Business Mailing Address
First Line	:	312 JASON DR STE 9
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2785
Country	:	US
Telephone Number	:	859-575-4075
Fax Number	:	859-575-4126

Provider Business Practice Location Address
First Line	:	312 JASON DR STE 9
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2785
Country	:	US
Telephone Number	:	859-575-4075
Fax Number	:	859-575-4126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	03/24/2023

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