MEDICARE: MICHAEL K SOWELL 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	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	29570	KY
2	2084N0400X	Neurology Physician	29570	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578561742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL K SOWELL M.D.

Provider Business Mailing Address
First Line	:	401 E CHESTNUT ST
Second Line	:	SUITE 510
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-5700
Country	:	US
Telephone Number	:	502-589-0802
Fax Number	:	502-589-0805

Provider Business Practice Location Address
First Line	:	401 E CHESTNUT ST
Second Line	:	SUITE 510
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-5700
Country	:	US
Telephone Number	:	502-589-0802
Fax Number	:	502-589-0805

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	10/27/2020

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