Healthcare Provider Details

I. General information

NPI: 1144360389
Provider Name (Legal Business Name): LEXINGTON FOOT & ANKLE CENTER PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 LEXINGTON RD SUITE 210
GEORGETOWN KY
40324-9672
US

IV. Provider business mailing address

1138 LEXINGTON RD SUITE 210
GEORGETOWN KY
40324-9672
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-8855
  • Fax: 859-278-8856
Mailing address:
  • Phone: 859-278-8855
  • Fax: 859-278-8856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00236
License Number StateKY

VIII. Authorized Official

Name: MICHAEL ALLEN
Title or Position: CEO
Credential: DPM
Phone: 859-278-8855