Healthcare Provider Details

I. General information

NPI: 1104183235
Provider Name (Legal Business Name): MICHAEL EMERSON HOGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 DUTCHMANS LN
LOUISVILLE KY
40207-4714
US

IV. Provider business mailing address

9152 TAYLORSVILLE RD # 276
LOUISVILLE KY
40299-1752
US

V. Phone/Fax

Practice location:
  • Phone: 502-447-8786
  • Fax: 502-447-8623
Mailing address:
  • Phone: 502-447-8786
  • Fax: 24-478-6235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number51016
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number079742
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: