Provider Demographics
NPI:1609983048
Name:SINCLAIR, KEITH G (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:G
Last Name:SINCLAIR
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 1:225 NESMIN LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-5659
Mailing Address - Country:US
Mailing Address - Phone:606-146-7485
Mailing Address - Fax:606-249-9994
Practice Address - Street 1:79 IMAGING DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2869
Practice Address - Country:US
Practice Address - Phone:606-305-8022
Practice Address - Fax:606-249-9994
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28427208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64284276Medicaid
KY1169803Medicare PIN