Provider Demographics
NPI:1912050519
Name:DICKEN, EVAN KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:KEITH
Last Name:DICKEN
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 1:601 VERSAILLES RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-3857
Mailing Address - Country:US
Mailing Address - Phone:502-695-3946
Mailing Address - Fax:502-695-3847
Practice Address - Street 1:601 VERSAILLES RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-3857
Practice Address - Country:US
Practice Address - Phone:502-695-3946
Practice Address - Fax:502-695-3847
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine