Individual
MITCHAEL GENE ESTRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1401 HARRODSBURG RD, SUITE A-510, LEXINGTON, KY 40504-3751
(859) 258-6784
(859) 258-6796
Mailing address
1401 HARRODSBURG RD, SUITE A-510, LEXINGTON, KY 40504-3751
(859) 258-6784
(859) 258-6796
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
24442
KY
208M00000X
Hospitalist Physician
Primary
24442
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110055339
RAILROAD MEDICARE PIN
KY
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
05
—
64000912
—
KY
01
—
CB5773
RAILROAD MEDICARE GROUP
KY
Enumeration date
07/05/2006
Last updated
10/20/2011
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