Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 8871 | KY |
Y | 213EG0000X | General Practice | 8871 | KY |
NPI | 1003127721 |
---|---|
Provider Name | Mary Margaret Lee |
First Address | Louisville, KY 40206-3268 |
Second Address | Louisville, KY 40202-1740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2010 |
Last Update Date | 16/02/2011 |