Provider Demographics
NPI:1487755740
Name:C. MICHAEL LITTLEJOHN, MD, PSC
Entity type:Organization
Organization Name:C. MICHAEL LITTLEJOHN, MD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LITTLEJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-365-3343
Mailing Address - Street 1:1100 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-2379
Mailing Address - Country:US
Mailing Address - Phone:270-365-3343
Mailing Address - Fax:270-365-4467
Practice Address - Street 1:1100 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-2379
Practice Address - Country:US
Practice Address - Phone:270-365-3343
Practice Address - Fax:270-365-4467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64305063Medicaid
1874701Medicare ID - Type Unspecified
KY64305063Medicaid