Healthcare Provider Details

I. General information

NPI: 1518313824
Provider Name (Legal Business Name): MATTHEW BLACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE J301
LEXINGTON KY
40536-2818
US

IV. Provider business mailing address

740 SOUTH LIMESTONE SUITE K301
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-1691
  • Fax: 859-323-1700
Mailing address:
  • Phone: 859-323-4661
  • Fax: 859-257-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2023-02598
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number61145
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036155268
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: