Provider Demographics
NPI:1669517454
Name:BELANGER, JOHN STROTHER (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:STROTHER
Last Name:BELANGER
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 1:1010 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:MC KEE
Mailing Address - State:KY
Mailing Address - Zip Code:40447-7089
Mailing Address - Country:US
Mailing Address - Phone:859-626-7700
Mailing Address - Fax:859-626-7890
Practice Address - Street 1:480 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PAINT LICK
Practice Address - State:KY
Practice Address - Zip Code:40461
Practice Address - Country:US
Practice Address - Phone:859-925-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64266570Medicaid
KY64266570Medicaid