Provider Demographics
NPI:1538299698
Name:MORRILL, MICHAEL JUSTIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JUSTIN
Last Name:MORRILL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2692 RICHMOND ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509
Mailing Address - Country:US
Mailing Address - Phone:859-268-2190
Mailing Address - Fax:859-268-2168
Practice Address - Street 1:2692 RICHMOND ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509
Practice Address - Country:US
Practice Address - Phone:859-268-2190
Practice Address - Fax:859-268-2168
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00199213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80001993Medicaid
G233OtherBCBS
KY2010001Medicare PIN
KY80001993Medicaid
0665520001Medicare NSC