Organization
KENTUCKY DERMATOLOGY AND SKIN CANCER CLINIC, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAYE FENSTERMAKER (PRACTICE MANAGER)
(859) 276-1511
Entity
Organization
Contact information
Practice address
177 BURT RD, LEXINGTON, KY 40503-2410
(859) 276-1511
(859) 276-3373
Mailing address
177 BURT RD, LEXINGTON, KY 40503-2410
(859) 276-1511
(859) 276-3373
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
207N00000X
Dermatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C16315
RR MEDICARE
KY
Enumeration date
05/01/2007
Last updated
08/27/2020
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