Healthcare Provider Details

I. General information

NPI: 1023675964
Provider Name (Legal Business Name): MICHAEL PAUL HENDRICKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 HARRODSBURG RD FL 2
LEXINGTON KY
40504-3516
US

IV. Provider business mailing address

571 S FLOYD ST STE 432
LOUISVILLE KY
40202-3877
US

V. Phone/Fax

Practice location:
  • Phone: 859-562-1868
  • Fax: 859-257-0421
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number59373
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: