Provider Demographics
NPI:1386792067
Name:M2K INTERNAL MEDICINE, PLLC
Entity type:Organization
Organization Name:M2K INTERNAL MEDICINE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:GRIGSBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-233-1490
Mailing Address - Street 1:120 N EAGLE CREEK DR
Mailing Address - Street 2:SUITE 321
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1827
Mailing Address - Country:US
Mailing Address - Phone:859-233-1490
Mailing Address - Fax:859-264-8026
Practice Address - Street 1:120 N EAGLE CREEK DR
Practice Address - Street 2:SUITE 321
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1827
Practice Address - Country:US
Practice Address - Phone:859-233-1490
Practice Address - Fax:859-264-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7616Medicare ID - Type Unspecified