Provider Demographics
NPI:1548594716
Name:HAMILTON, MICHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 IVAL JAMES BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8174
Mailing Address - Country:US
Mailing Address - Phone:859-353-5907
Mailing Address - Fax:859-353-5683
Practice Address - Street 1:2187 LEXINGTON RD STE B1
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7919
Practice Address - Country:US
Practice Address - Phone:859-353-5907
Practice Address - Fax:859-353-5683
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC042363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant