=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285831826
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAN D HONAKER, MD PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2007
-----------------------------------------------------
Last Update Date | 09/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 231 MIDLAND PARK
-----------------------------------------------------
City | SHELBYVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40065-9735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-633-6040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 231 MIDLAND PARK
-----------------------------------------------------
City | SHELBYVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40065-9735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-633-6040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RECEPTIONIST
-----------------------------------------------------
Name | MS. KATHRYN DLANE SANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-633-6040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 15137
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------