Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 51462 | KY |
NPI | 1578722906 |
---|---|
Provider Name | Dr. Blaine Thomas Mischen |
First Address | Charleston, SC 29425-8905 |
Second Address | Lexington, KY 40536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2008 |
Last Update Date | 13/07/2018 |