Provider Demographics
NPI:1083670467
Name:LITTRELL, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LITTRELL
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-212-4700
Mailing Address - Fax:859-212-4761
Practice Address - Street 1:7370 TURFWAY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4895
Practice Address - Country:US
Practice Address - Phone:859-212-4700
Practice Address - Fax:859-212-4761
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64261977Medicaid
OH2152656Medicaid
OH080129873Medicare PIN
KY0553602Medicare PIN
F09044Medicare UPIN
OH2152656Medicaid
P00685179Medicare PIN