MEDICARE: BLUEGRASS PLASTIC & RECONSTRUCTIVE SURGERY

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	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1922213586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEGRASS PLASTIC & RECONSTRUCTIVE SURGERY

Provider Business Mailing Address
First Line	:	1707 NICHOLASVILLE RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1403
Country	:	US
Telephone Number	:	859-276-5577
Fax Number	:	859-277-4048

Provider Business Practice Location Address
First Line	:	1707 NICHOLASVILLE RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1403
Country	:	US
Telephone Number	:	859-276-5577
Fax Number	:	859-277-4048

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DOROTHY H. CLARK
Credential	:	M.D.
Telephone Number	:	859-276-5577

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

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Practice Location Address:

1707 NICHOLASVILLE RD
LEXINGTON, KY
40503-1403

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Practice Fax: 859-277-4048

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Practice Location Address:

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Practice Location Address:

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Practice Location Address:

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Directions to “BLUEGRASS PLASTIC & RECONSTRUCTIVE SURGERY ” Practice Location

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