| Organization Name: | GREG MICK D.O., PLLC |
| NPI Number: | 1215320056 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN DANIELS (MANAGER) |
| Mailing Address: | 2375 Professional Heights Dr Suite 240 Lexington |
| State: | KY US |
| Postal Code: | 405033040 |
| Phone Number: | 8595238996 |
| Fax Number: | 8595239370 |
| NPI Enumeration Date: | 03/17/2015 |
| NPI Last Update Date: | 03/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 02503 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |