Provider Demographics
NPI:1033273610
Name:FLEMING, MICHAEL W (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:FLEMING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 NEW LAGRANGE RD
Mailing Address - Street 2:STE. 301
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4870
Mailing Address - Country:US
Mailing Address - Phone:502-425-3815
Mailing Address - Fax:502-425-3741
Practice Address - Street 1:7400 NEW LAGRANGE RD
Practice Address - Street 2:STE. 301
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4870
Practice Address - Country:US
Practice Address - Phone:502-425-3815
Practice Address - Fax:502-425-3741
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY214992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64214992Medicaid
KY21499OtherSTATE LICENSE #
KYAF1176898OtherDEA #
KY64214992Medicaid
KY21499OtherSTATE LICENSE #