Healthcare Provider Details

I. General information

NPI: 1760544175
Provider Name (Legal Business Name): MICHAEL T SEWELL MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 PENNSYLVANIA AVE
BARDSTOWN KY
40004-2529
US

IV. Provider business mailing address

875 PENNSYLVANIA AVE
BARDSTOWN KY
40004-2529
US

V. Phone/Fax

Practice location:
  • Phone: 502-348-5685
  • Fax: 502-348-1771
Mailing address:
  • Phone: 502-348-5685
  • Fax: 502-348-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number20940
License Number StateKY

VIII. Authorized Official

Name: DR. MICHAEL THOMAS SEWELL
Title or Position: PRESIDENT
Credential: MD
Phone: 502-348-5685