Provider Demographics
NPI:1336343938
Name:BASS, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:BASS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:216 FOUNTAIN COURT
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509
Mailing Address - Country:US
Mailing Address - Phone:859-543-1024
Mailing Address - Fax:859-543-0141
Practice Address - Street 1:216 FOUNTAIN COURT
Practice Address - Street 2:SUITE 160
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509
Practice Address - Country:US
Practice Address - Phone:859-543-1024
Practice Address - Fax:859-543-0141
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2016-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXBP1-00168362086S0122X
KY40717208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
939764608OtherMYUTMB 939764608-COMMERCIAL NUMBER
939764608OtherMYUTMB 939764608-COMMERCIAL NUMBER