Healthcare Provider Details

I. General information

NPI: 1710939830
Provider Name (Legal Business Name): BARBARA A MICHNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRILLIUM WAY SUITE 301
CORBIN KY
40701-8727
US

IV. Provider business mailing address

PO BOX 1325
CORBIN KY
40702-1325
US

V. Phone/Fax

Practice location:
  • Phone: 606-526-7363
  • Fax: 606-526-8695
Mailing address:
  • Phone: 606-526-8131
  • Fax: 606-528-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number45657
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: