Healthcare Provider Details

I. General information

NPI: 1902903016
Provider Name (Legal Business Name): MICHAEL THOMAS SEWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/05/2013
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:
Mailing address:
  • Phone: 502-348-5685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20940
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: