Healthcare Provider Details

I. General information

NPI: 1841605870
Provider Name (Legal Business Name): MICHAEL TOTTEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2014
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S BROADWAY
LEXINGTON KY
40504-2701
US

IV. Provider business mailing address

1221 S BROADWAY
LEXINGTON KY
40504-2701
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-4271
  • Fax: 859-258-4296
Mailing address:
  • Phone: 859-258-4271
  • Fax: 859-258-4296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number52847
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: