Provider Demographics
NPI:1467554808
Name:PAYNE, MICHAEL S (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:PAYNE
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 1:532 N BARDSTOWN RD
Mailing Address - Street 2:PO BOX 67
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047
Mailing Address - Country:US
Mailing Address - Phone:502-538-4800
Mailing Address - Fax:502-538-3040
Practice Address - Street 1:532 N BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047
Practice Address - Country:US
Practice Address - Phone:502-538-4800
Practice Address - Fax:502-538-3040
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34039207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00080686OtherRAILROAD MEDICARE
2443395000OtherPASSPORT ADVANTAGE
KY50001836OtherPASSPORT
KY64011109Medicaid
7088131OtherAETNA
000000306485OtherBCBS
7088131OtherAETNA
KYH19623Medicare UPIN