Healthcare Provider Details

I. General information

NPI: 1053026351
Provider Name (Legal Business Name): MITCHELL HEGES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 BRECKENRIDGE ST
LEXINGTON KY
40508-2255
US

IV. Provider business mailing address

561 BRECKENRIDGE ST
LEXINGTON KY
40508-2255
US

V. Phone/Fax

Practice location:
  • Phone: 859-285-7941
  • Fax:
Mailing address:
  • Phone: 859-285-7941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: