MEDICARE: LEONARD CURTIS FUGATE JR. PA

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	363AM0700X	Medical Physician Assistant	PA799	KY
2	363AS0400X	Surgical Physician Assistant	PA799	KY
3	363A00000X	Physician Assistant	PA799	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00459649	OTHER	KY	RAILROAD MEDICARE

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

General Provider Information

NPI Number	:	1942277934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD CURTIS FUGATE JR. PA

Provider Business Mailing Address
First Line	:	3209 SOLUTIONS CENTER
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-0001
Country	:	US
Telephone Number	:	502-212-4759
Fax Number	:	502-471-2051

Provider Business Practice Location Address
First Line	:	245 FOUNTAIN CT FL 1
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-2792
Country	:	US
Telephone Number	:	859-218-2626
Fax Number	:	859-257-3322

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	12/14/2022

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