Provider Demographics
NPI:1295737955
Name:CECIL, MICHAEL T (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:CECIL
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 1:350 ELAINE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2754
Mailing Address - Country:US
Mailing Address - Phone:859-258-4339
Mailing Address - Fax:859-258-6122
Practice Address - Street 1:1221 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-4371
Practice Address - Fax:859-258-4326
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39524207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64107790Medicaid
I30461Medicare UPIN
KY64107790Medicaid
KY0687906Medicare ID - Type Unspecified
GAP00232452Medicare PIN
KY00637079Medicare PIN
KY0169Medicare PIN