Michael A McKibben, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

37619 Issued in KY

Practice address

189 Outer Loop
Louisville, KY 40214-5544

Phone

(502) 363-1731

Fax

(502) 364-9272

NPI assigned

May 26, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429228800000",
    "number": "1881640936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 950202",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402950202",
            "telephone_number": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 OUTER LOOP",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402145544",
            "telephone_number": "502-363-1731",
            "fax_number": "502-364-9272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKIBBEN",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2015-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "37619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64065600",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM-NCMA",
            "identifier": "000000880859",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIHO-NCMA",
            "identifier": "162141",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "50070407",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Carolyn McKenzie, M.D.
• Keith McKenzie, CADC
• Laura McKenzie
• Madelyn McKenzie, MD
• Peter David McKenzie
• James E McKiernan, MD
• Patrick Michael McKiernan, PHD
• Virginia R McKiernan, OTR
• Christi Danielle McKim, MS, OTR/L, ATP
• Chrisann McKinley, PTA

• Family Medicine Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Family Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.