Provider Demographics
NPI:1518143577
Name:HOUK, BRANDON LYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:LYLE
Last Name:HOUK
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 1:2413 RING RD
Mailing Address - Street 2:STE 122
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-5936
Mailing Address - Country:US
Mailing Address - Phone:270-763-0067
Mailing Address - Fax:
Practice Address - Street 1:2413 RING RD
Practice Address - Street 2:STE 122
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5936
Practice Address - Country:US
Practice Address - Phone:270-763-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41925207RA0401X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100049980Medicaid
KY50021144OtherPASSPORT
KY00701001Medicare PIN