Healthcare Provider Details

I. General information

NPI: 1770609125
Provider Name (Legal Business Name): PAUL B MCKEE IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ABRAHAM FLEXNER WAY SUITE 100
LOUISVILLE KY
40202-3841
US

IV. Provider business mailing address

100 E LIBERTY ST SUITE 800
LOUISVILLE KY
40202-1434
US

V. Phone/Fax

Practice location:
  • Phone: 502-587-8222
  • Fax: 502-587-0860
Mailing address:
  • Phone: 502-587-8222
  • Fax: 502-587-0860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number42886
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: