Provider Demographics
NPI:1699709774
Name:NORELLE, ALEXIS (MD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:NORELLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:SUITE A-540
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-258-6760
Mailing Address - Fax:859-258-6512
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:SUITE A-540
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-258-6760
Practice Address - Fax:859-258-6512
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38903207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64090863Medicaid
KY36000818OtherMEDICAID ASC GROUP
KY37903705OtherMEDICAID LAB GROUP
KYASC1019OtherMEDICARE ASC GROUP
P00184659OtherRR MEDICARE PIN
KY4000501OtherMEDICARE LAB GROUP
CB5773OtherRR MEDICARE GROUP
KYF27445Medicare UPIN
KYASC1019OtherMEDICARE ASC GROUP