Provider Demographics
NPI:1376631622
Name:HATFIELD, COREY MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:MICHAEL
Last Name:HATFIELD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 WALLER AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2931
Mailing Address - Country:US
Mailing Address - Phone:859-254-7000
Mailing Address - Fax:859-255-4381
Practice Address - Street 1:330 WALLER AVE
Practice Address - Street 2:STE. 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2931
Practice Address - Country:US
Practice Address - Phone:859-254-7000
Practice Address - Fax:859-255-4381
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL920207R00000X
SC920207R00000X, 207RR0500X
KY03745207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100304620Medicaid
KYK167340Medicare PIN