Healthcare Provider Details

I. General information

NPI: 1932188109
Provider Name (Legal Business Name): SUSAN E SPIRES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S LIMESTONE
LEXINGTON KY
40508-3008
US

IV. Provider business mailing address

2560 N SHADELAND AVE SUITE A
INDIANAPOLIS IN
46219-1706
US

V. Phone/Fax

Practice location:
  • Phone: 859-226-7094
  • Fax: 859-226-7859
Mailing address:
  • Phone: 317-275-8072
  • Fax: 317-275-8018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number19036
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: