Provider Demographics
NPI:1851828594
Name:HURLESS, MICHELLE A (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:A
Last Name:HURLESS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:KLAUSING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3684 STOLEN HORSE TRCE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2144
Mailing Address - Country:US
Mailing Address - Phone:419-615-3499
Mailing Address - Fax:
Practice Address - Street 1:2700 OLD ROSEBUD RD STE 110
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8624
Practice Address - Country:US
Practice Address - Phone:859-264-1141
Practice Address - Fax:859-264-1963
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY264227213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100687520Medicaid