Individual
MICHAEL A MCKIBBEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
189 OUTER LOOP, LOUISVILLE, KY 40214-5544
(502) 363-1731
(502) 364-9272
Mailing address
PO BOX 950202, LOUISVILLE, KY 40295-0202
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
37619
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000880859
ANTHEM-NCMA
KY
01
—
162141
SIHO-NCMA
KY
01
—
50070407
PASSPORT
KY
05
—
64065600
—
KY
Enumeration date
05/26/2006
Last updated
04/17/2015
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