Healthcare Provider Details

I. General information

NPI: 1578561742
Provider Name (Legal Business Name): MICHAEL K SOWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CHESTNUT ST SUITE 510
LOUISVILLE KY
40202-5700
US

IV. Provider business mailing address

401 E CHESTNUT ST SUITE 510
LOUISVILLE KY
40202-5700
US

V. Phone/Fax

Practice location:
  • Phone: 502-589-0802
  • Fax: 502-589-0805
Mailing address:
  • Phone: 502-589-0802
  • Fax: 502-589-0805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number29570
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number29570
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: