Healthcare Provider Details

I. General information

NPI: 1649848771
Provider Name (Legal Business Name): CODY ALEXANDER VAN LINGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 S LOOP RD
EDGEWOOD KY
41017-5446
US

IV. Provider business mailing address

413 S LOOP RD
EDGEWOOD KY
41017-5446
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-3800
  • Fax:
Mailing address:
  • Phone: 859-301-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.00732191
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.00732191
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: