Provider Demographics
NPI:1174543722
Name:GEILE, SANDRA (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GEILE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-1841
Mailing Address - Country:US
Mailing Address - Phone:859-734-5173
Mailing Address - Fax:859-734-9925
Practice Address - Street 1:466 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-1841
Practice Address - Country:US
Practice Address - Phone:859-734-5173
Practice Address - Fax:859-734-9925
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36735207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004514Medicaid
KY000000259688OtherANTHEM
WV3000103OtherBWC
KYP00037844OtherRR- MEDICARE
KY50005458OtherPASSPORT
KY64056666Medicaid
WV3000103OtherBWC
WV3810004514Medicaid
KYK024330Medicare PIN