Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MT183311 | PA |
N | 111NI0900X | Internist | MT183311 | PA |
Y | 207RN0300X | Nephrologist | 43697 | KY |
NPI | 1063661445 |
---|---|
Provider Name | Dr. Lina Mackelaite |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-1715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2008 |
Last Update Date | 29/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100134410 | (05) | KY |