Provider Demographics
NPI:1609934777
Name:MCINTOSH, MICHAEL GENE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GENE
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1717 DIXIE HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011
Mailing Address - Country:US
Mailing Address - Phone:839-578-4143
Mailing Address - Fax:859-344-3183
Practice Address - Street 1:1717 DIXIE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41011
Practice Address - Country:US
Practice Address - Phone:839-578-4143
Practice Address - Fax:859-344-3183
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY194082084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64194087Medicaid
1051101Medicare ID - Type Unspecified