Healthcare Provider Details

I. General information

NPI: 1801115522
Provider Name (Legal Business Name): GERMAN S FIKHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JERRY S FIKHMAN M.D.

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 RING RD STE 105
ELIZABETHTOWN KY
42701-5930
US

IV. Provider business mailing address

PO BOX 2119
ELIZABETHTOWN KY
42702-2119
US

V. Phone/Fax

Practice location:
  • Phone: 270-706-5265
  • Fax: 270-706-5523
Mailing address:
  • Phone: 270-706-5265
  • Fax: 270-706-5523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number49517
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: