Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | TP403 | KY |
NPI | 1023372034 |
---|---|
Provider Name | Indu Elizabeth Mathew |
First Address | Lexington, KY 40513-1900 |
Second Address | Lexington, KY 40536-0293 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2012 |
Last Update Date | 06/07/2015 |