Provider Demographics
NPI:1093968026
Name:NEWCOMB, MICHAEL THORNTON (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THORNTON
Last Name:NEWCOMB
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:350 ELAINE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2754
Mailing Address - Country:US
Mailing Address - Phone:859-258-4339
Mailing Address - Fax:859-258-6122
Practice Address - Street 1:100 N EAGLE CREEK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1805
Practice Address - Country:US
Practice Address - Phone:859-258-5310
Practice Address - Fax:859-258-6123
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2012-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY45025207W00000X
KYR1832207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0169OtherLC MEDICARE GROUP ID NUMBER
KY65923740OtherLC MEDICAID GROUP NUMBER