Provider Demographics
NPI:1104832310
Name:PIKE, SAMUEL PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:PHILLIP
Last Name:PIKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:100 HELMWOOD PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701
Mailing Address - Country:US
Mailing Address - Phone:270-765-6242
Mailing Address - Fax:270-765-6243
Practice Address - Street 1:100 HELMWOOD PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-765-6242
Practice Address - Fax:270-765-6243
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000047212OtherANTHEM
KY000000047212OtherANTHEM
KY0985101Medicare ID - Type Unspecified