Provider Demographics
NPI:1952512030
Name:MARKHAM, MICHAEL LANE (MED)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LANE
Last Name:MARKHAM
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1382 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-2351
Mailing Address - Country:US
Mailing Address - Phone:502-637-4361
Mailing Address - Fax:502-637-4490
Practice Address - Street 1:1382 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2351
Practice Address - Country:US
Practice Address - Phone:502-637-4361
Practice Address - Fax:502-637-4490
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker