Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | KY03698 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 03698 | KY |
NPI | 1285921932 |
---|---|
Provider Name | Robin Mchale Polly |
First Address | Lexington, KY 40502 |
Second Address | Lexington, KY 40502-2235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2011 |
Last Update Date | 24/02/2021 |