MEDICARE: MR. MICHAEL BOYD MCDANIEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1194056762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL BOYD MCDANIEL

Provider Business Mailing Address
First Line	:	746 SEATTLE DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-2127
Country	:	US
Telephone Number	:	859-260-1923
Fax Number	:

Provider Business Practice Location Address
First Line	:	746 SEATTLE DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-2127
Country	:	US
Telephone Number	:	859-260-1923
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	01/21/2010

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