Individual
DR. MICHAEL WAYNE MCQUILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4001 KRESGE WAY, SUITE 100, LOUISVILLE, KY 40207-4640
(502) 897-6579
(502) 897-2725
Mailing address
2700 STANLEY GAULT PKWY, SUITE 129, LOUISVILLE, KY 40223-5132
(502) 253-4917
(502) 489-5751
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
39813
KY
207X00000X
Orthopaedic Surgery Physician
Primary
39813
KY
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
39813
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64125750
—
KY
Enumeration date
05/03/2006
Last updated
12/09/2020
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