Provider Demographics
NPI:1083615207
Name:HESS, MICHAEL CARL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CARL
Last Name:HESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-969-6552
Mailing Address - Fax:502-969-3799
Practice Address - Street 1:5334 S 3RD ST
Practice Address - Street 2:SOUTHEND MEDICAL CENTER
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-2612
Practice Address - Country:US
Practice Address - Phone:502-367-2288
Practice Address - Fax:502-367-0108
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY19773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00298562OtherRR MEDICARE
KY0992805Medicare PIN
KYP00298562OtherRR MEDICARE