Individual
MR. MICHAEL LOWELL BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3480 YORKSHIRE MEDICAL PARK, LEXINGTON, KY 40509-1886
(859) 263-5140
Mailing address
3480 YORKSHIRE MEDICAL PARK, LEXINGTON, KY 40509-1886
(859) 263-5140
(859) 263-5141
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA934
KY
363AS0400X
Surgical Physician Assistant
PA934
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95006094
—
KY
Enumeration date
04/20/2006
Last updated
12/31/2019
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