Provider Demographics
NPI:1255304192
Name:HARKABUS, MICHAEL ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:HARKABUS
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 1:110 SAGAMORE ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601
Mailing Address - Country:US
Mailing Address - Phone:502-352-1837
Mailing Address - Fax:
Practice Address - Street 1:CAPITAL SURGICAL CLINIC
Practice Address - Street 2:ONE PHYSICIANS PARK
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4107
Practice Address - Country:US
Practice Address - Phone:502-223-7629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40042208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02554348Medicaid
COCO306744Medicare PIN