Healthcare Provider Details

I. General information

NPI: 1265828404
Provider Name (Legal Business Name): MICHAEL PATRICK HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 BEVINS LN
GEORGETOWN KY
40324-6178
US

IV. Provider business mailing address

1777 ASHLEY CIR
BOWLING GREEN KY
42104-3339
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-9333
  • Fax: 502-570-5063
Mailing address:
  • Phone: 270-781-4090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberH11-114-345
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51315
License Number StateKY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: