Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 35090995 | OH |
NPI | 1659570455 |
---|---|
Provider Name | Mr. Kevin T. Lie |
First Address | Newark, DE 19718 |
Second Address | Newark, DE 19718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 27/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1025726440001 | (05) | PA |
204881619259 | CARESOURCE (01) | OH |
2788381 | (05) | OH |
465114 | WELLCARE (01) | OH |
P00648554 | RAILROAD MEDICARE (01) | OH |