Provider Demographics
NPI:1760544175
Name:MICHAEL T SEWELL MD PSC
Entity Type:Organization
Organization Name:MICHAEL T SEWELL MD PSC
Other - Org Name:BLUESTAR ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-348-5685
Mailing Address - Street 1:875 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2529
Mailing Address - Country:US
Mailing Address - Phone:502-348-5685
Mailing Address - Fax:502-348-1771
Practice Address - Street 1:875 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2529
Practice Address - Country:US
Practice Address - Phone:502-348-5685
Practice Address - Fax:502-348-1771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20940173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64209406Medicaid
KY0147120001Medicare NSC
KY00198002Medicare PIN
KYC75485Medicare UPIN
KY1413701Medicare ID - Type Unspecified