Basic Information
| Provider Information | |||||||||
| NPI: | 1225422041 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESIMONE | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 HOSPITAL WAY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425032872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064515093 | ||||||||
| FaxNumber: | 6064515087 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 HOSPITAL WAY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425032872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064515093 | ||||||||
| FaxNumber: | 6064515087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2015 | ||||||||
| LastUpdateDate: | 04/03/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 04123 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.