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NPI Code Detail

MEDICARE: MR. MICHAEL LOWELL BLACKBURN PA-C

MEDICARE: MR. MICHAEL LOWELL BLACKBURN PA-C
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
1363AS0400XSurgical Physician AssistantPA934KY
2363A00000XPhysician AssistantPA934KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639134679
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL LOWELL BLACKBURN PA-C
Provider Business Mailing Address
First Line : 3480 YORKSHIRE MEDICAL PARK
Second Line :
City : LEXINGTON
State : KY
Zip : 40509-1886
Country : US
Telephone Number : 859-263-5140
Fax Number : 859-263-5141
Provider Business Practice Location Address
First Line : 3480 YORKSHIRE MEDICAL PARK
Second Line :
City : LEXINGTON
State : KY
Zip : 40509-1886
Country : US
Telephone Number : 859-263-5140
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2006
Last Update Date : 12/31/2019

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