1295899227 NPI number — TODD FLESHMAN OD

Table of content: TODD FLESHMAN OD (NPI 1295899227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295899227 NPI number — TODD FLESHMAN OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLESHMAN
Provider First Name:
TODD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295899227
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
181 HIGHWAY 44 E
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
SHEPHERDSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40165-6081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-779-3002
Provider Business Mailing Address Fax Number:
502-736-4490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10639 DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40272-4349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-933-9200
Provider Business Practice Location Address Fax Number:
502-736-4490
Provider Enumeration Date:
12/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1240DT , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 77012409 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".