Healthcare Provider Details

I. General information

NPI: 1932204088
Provider Name (Legal Business Name): TIMOTHY SHAWN CAUDILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S LIMESTONE
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

830 S LIMESTONE STE 304
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-0303
  • Fax: 859-323-1200
Mailing address:
  • Phone: 859-323-0303
  • Fax: 859-323-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24731
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: