Healthcare Provider Details

I. General information

NPI: 1003053117
Provider Name (Legal Business Name): KENNETH MICHAEL FARMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17718 POPEDALE RD
LOUISVILLE KY
40245-4353
US

IV. Provider business mailing address

17718 POPEDALE RD
LOUISVILLE KY
40245-4353
US

V. Phone/Fax

Practice location:
  • Phone: 502-245-5452
  • Fax:
Mailing address:
  • Phone: 502-245-5452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number16782
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: