Provider Demographics
NPI:1063476216
Name:FLETCHER, MICHAEL EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EUGENE
Last Name:FLETCHER
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 1:8780 US HIGHWAY 42 STE E
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-6936
Mailing Address - Country:US
Mailing Address - Phone:859-495-7246
Mailing Address - Fax:859-292-0131
Practice Address - Street 1:8780 US HIGHWAY 42 STE E
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-6936
Practice Address - Country:US
Practice Address - Phone:859-495-7246
Practice Address - Fax:859-292-0131
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31154207LA0401X, 207QA0401X, 208VP0014X
OH35.092370207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2838808Medicaid
KY64311541Medicaid
OH2838808Medicaid
KY64311541Medicaid