Basic Information
| Provider Information | |||||||||
| NPI: | 1649298779 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROWE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | KEVIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 140 NEWCOMB AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404562728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062564148 | ||||||||
| FaxNumber: | 6062565191 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 NEWCOMB AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404562728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062564148 | ||||||||
| FaxNumber: | 6062565191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 03/17/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35006 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 35006 | KY | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00082670 | 01 | KY | RAILROAD MEDICARE | OTHER | 000001179912 | 01 | KY | CHA | OTHER | P00082670 | 01 | OH | RAILROAD MEDICARE | OTHER | 0102112 | 01 | KY | UNITED HEALTHCARE | OTHER | 163543300 | 01 | KY | DEPARTMENT OF LABOR | OTHER | 000000197553 | 01 | KY | ANTHEM BC / BS | OTHER | 64035884 | 05 | KY | MEDICAID |