Healthcare Provider Details

I. General information

NPI: 1609939032
Provider Name (Legal Business Name): LEXINGTON FOOT AND ANKLE CENTER PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD C115
LEXINGTON KY
40504-3751
US

IV. Provider business mailing address

1401 HARRODSBURG RD C115
LEXINGTON KY
40504-3751
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-8855
  • Fax: 859-278-8856
Mailing address:
  • Phone: 859-278-8855
  • Fax: 859-278-8856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number213ES0103X
License Number StateKY

VIII. Authorized Official

Name: MICHAEL C ALLEN
Title or Position: CEO
Credential: DPM
Phone: 859-278-8855