Healthcare Provider Details

I. General information

NPI: 1902161896
Provider Name (Legal Business Name): MAUTIN TEMITOPE BARRY-HUNDEYIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2012
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST FL 1
LEXINGTON KY
40536-5501
US

IV. Provider business mailing address

800 ROSE ST FL 1
LEXINGTON KY
40536-7001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6542
  • Fax: 859-323-2074
Mailing address:
  • Phone: 859-259-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number252752
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberTP950
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: