Provider Demographics
NPI:1245235795
Name:APPLEGATE, KEITH T (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:T
Last Name:APPLEGATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1775 ALYSHEBA WAY
Mailing Address - Street 2:STE 201
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2279
Mailing Address - Country:US
Mailing Address - Phone:859-278-5007
Mailing Address - Fax:859-278-6867
Practice Address - Street 1:1775 ALYSHEBA WAY
Practice Address - Street 2:STE 201
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2279
Practice Address - Country:US
Practice Address - Phone:859-278-5007
Practice Address - Fax:859-278-6867
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY25088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64250889Medicaid
KY64250889Medicaid
KY1369302Medicare ID - Type Unspecified