Provider Demographics
NPI:1679591903
Name:MORTON, SUZANNE MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MICHELLE
Last Name:MORTON
Suffix:
Gender:F
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 FOUNTAIN CT STE 210
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2696
Practice Address - Country:US
Practice Address - Phone:859-629-7280
Practice Address - Fax:859-629-7281
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34366207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64070097Medicaid
H84258Medicare UPIN
KY64070097Medicaid
KY0768401Medicare ID - Type Unspecified
KY37903705OtherMEDICAID LAB GROUP
H84258Medicare UPIN
KY64070097Medicaid