Healthcare Provider Details

I. General information

NPI: 1376631622
Provider Name (Legal Business Name): COREY MICHAEL HATFIELD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 WALLER AVE STE. 100
LEXINGTON KY
40504-2931
US

IV. Provider business mailing address

330 WALLER AVE STE. 100
LEXINGTON KY
40504-2931
US

V. Phone/Fax

Practice location:
  • Phone: 859-254-7000
  • Fax: 859-255-4381
Mailing address:
  • Phone: 859-254-7000
  • Fax: 859-255-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL920
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number920
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number920
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number03745
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: