Healthcare Provider Details

I. General information

NPI: 1407805617
Provider Name (Legal Business Name): ERIC ENDEAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 SOUTH LIMESTONE
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

800 ROSE STREET C215
LEXINGTON KY
50436-0293
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-3253
  • Fax:
Mailing address:
  • Phone: 859-323-6346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number26211
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: