Healthcare Provider Details

I. General information

NPI: 1235163510
Provider Name (Legal Business Name): MICHAEL DAVID HAMILTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 NEWCOMB AVE
MOUNT VERNON KY
40456-2728
US

IV. Provider business mailing address

RR 3 BOX 449
MOUNT VERNON KY
40456-8855
US

V. Phone/Fax

Practice location:
  • Phone: 606-256-2195
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number32467
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: