MEDICARE: MRS. ANITA J FLEENOR-FORD M.D.

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	207RI0200X	Infectious Disease Physician	34325	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	34325	OTHER	KY	KY STATE LIC.
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000282527	OTHER	KY	ANTHEM BCBS

General Provider Information

NPI Number	:	1740284348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANITA J FLEENOR-FORD M.D.

Provider Business Mailing Address
First Line	:	1903 BROADWAY
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-7105
Country	:	US
Telephone Number	:	270-444-9889
Fax Number	:	270-444-9291

Provider Business Practice Location Address
First Line	:	1903 BROADWAY
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-7105
Country	:	US
Telephone Number	:	270-444-9889
Fax Number	:	270-444-9291

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	08/09/2019

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