Provider Demographics
NPI:1578924197
Name:GRATEFUL DOC LLC
Entity Type:Organization
Organization Name:GRATEFUL DOC LLC
Other - Org Name:DEBBIE FIBEL MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-373-0643
Mailing Address - Street 1:2101 NICHOLASVILLE RD
Mailing Address - Street 2:#400
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2518
Mailing Address - Country:US
Mailing Address - Phone:859-373-0643
Mailing Address - Fax:859-912-7002
Practice Address - Street 1:2101 NICHOLASVILLE RD
Practice Address - Street 2:#400
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2518
Practice Address - Country:US
Practice Address - Phone:859-373-0643
Practice Address - Fax:859-912-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100392550Medicaid
KY7100392550Medicaid