Healthcare Provider Details

I. General information

NPI: 1871596643
Provider Name (Legal Business Name): MICHAEL LEE CUMMINGS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 FOOTHILLS AVE SUITE 1
ALBANY KY
42602-1076
US

IV. Provider business mailing address

127 FOOTHILLS AVE SUITE 1
ALBANY KY
42602-1076
US

V. Phone/Fax

Practice location:
  • Phone: 606-387-6627
  • Fax: 606-387-4178
Mailing address:
  • Phone: 606-387-6627
  • Fax: 606-387-4178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23083
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: