Healthcare Provider Details

I. General information

NPI: 1558301853
Provider Name (Legal Business Name): DENNIS HAVENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 NICHOLASVILLE RD STE 502
LEXINGTON KY
40503-1487
US

IV. Provider business mailing address

5200 COMMERCE CROSSINGS DR
LOUISVILLE KY
40229-2182
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-7129
  • Fax:
Mailing address:
  • Phone: 502-493-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number15324
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: