Healthcare Provider Details

I. General information

NPI: 1831293232
Provider Name (Legal Business Name): THOMAS KIRK SLABAUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD STE C215
LEXINGTON KY
40504-3774
US

IV. Provider business mailing address

1401 HARRODSBURG RD STE C215
LEXINGTON KY
40504-3751
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-6450
  • Fax: 859-258-6499
Mailing address:
  • Phone: 859-258-6450
  • Fax: 859-258-6499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number19375
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: