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General NPI Number Information
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NPI Number | 1285122341
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Entity Type | Individual
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Provider Name | SHAUN MICHAEL NORDECK MD
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Gender | Male
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 800 ROSE ST
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City | LEXINGTON
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State | KY
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Zip | 40536-1201
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Country | US
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Telephone | 859-323-2222
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Fax | 859-323-5090
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Provider Business Mailing Address
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Address Line | 5323 HARRY HINES BLVD
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City | DALLAS
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State | TX
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Zip | 75390-9316
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Country | US
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Telephone | 214-648-7236
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Fax | 214-648-8025
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | BP20066772
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | BP10062891
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 59690
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License Number State | KY
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