Healthcare Provider Details

I. General information

NPI: 1609887652
Provider Name (Legal Business Name): PHILLIP ANTHONY DESIMONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

2333 ALUMNI PARK PLZ STE 200
LEXINGTON KY
40517-4022
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5661
  • Fax:
Mailing address:
  • Phone: 859-218-5677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15703
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number15703
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number15703
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: