Provider Demographics
NPI:1144305285
Name:VEAZEY, MICHELLE AUST (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:AUST
Last Name:VEAZEY
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 1:40 N GRAND AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1765
Mailing Address - Country:US
Mailing Address - Phone:859-781-4900
Mailing Address - Fax:859-572-3035
Practice Address - Street 1:20 MEDICAL VILLAGE DR
Practice Address - Street 2:SUITE 268
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5401
Practice Address - Country:US
Practice Address - Phone:859-341-1100
Practice Address - Fax:859-344-4443
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41395207YX0602X, 207YX0901X, 207YP0228X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001874782Medicaid
000000542889OtherANTHEM
IN172650LMedicare PIN
F59679Medicare UPIN
050935Medicare ID - Type Unspecified
KY0216811Medicare PIN