Provider Demographics
NPI:1558468215
Name:SEDLAK, JUSTIN B (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:B
Last Name:SEDLAK
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 1:290 BIG RUN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2903
Mailing Address - Country:US
Mailing Address - Phone:859-278-9513
Mailing Address - Fax:
Practice Address - Street 1:290 BIG RUN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2903
Practice Address - Country:US
Practice Address - Phone:859-278-9513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30321207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000044324OtherBCBS PROVIDER NUMBER
KY30321OtherLICENSE
KY64303217Medicaid
KY000000804466OtherBCBS- MMC/POWDERLY CLINIC
KY30321OtherLICENSE
C70388Medicare UPIN
0374617Medicare PIN
KYK061190Medicare PIN
KYK061192Medicare PIN
000000044324OtherBCBS PROVIDER NUMBER
KY220027595Medicare PIN
KYK061191Medicare PIN
0374719Medicare PIN
0375061Medicare PIN
0376105Medicare PIN