Provider Demographics
NPI:1114087343
Name:CORNERSTONE ORTHOPAEDICS
Entity Type:Organization
Organization Name:CORNERSTONE ORTHOPAEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MICEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-626-9881
Mailing Address - Street 1:318 HIGHLAND PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475
Mailing Address - Country:US
Mailing Address - Phone:859-626-9881
Mailing Address - Fax:859-626-9790
Practice Address - Street 1:318 HIGHLAND PARK DRIVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475
Practice Address - Country:US
Practice Address - Phone:859-626-9881
Practice Address - Fax:859-626-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65940132Medicaid
KY7953Medicare ID - Type Unspecified