Healthcare Provider Details

I. General information

NPI: 1063476216
Provider Name (Legal Business Name): MICHAEL EUGENE FLETCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 02/07/2022
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8780 US HIGHWAY 42 STE E
FLORENCE KY
41042-6936
US

IV. Provider business mailing address

8780 US HIGHWAY 42 STE E
FLORENCE KY
41042-6936
US

V. Phone/Fax

Practice location:
  • Phone: 859-495-7246
  • Fax: 859-292-0131
Mailing address:
  • Phone: 859-495-7246
  • Fax: 859-292-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number31154
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number31154
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number35.092370
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number31154
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: