Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 51561 | KY |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 56224 | TN |
NPI | 1902164411 |
---|---|
Provider Name | Vincent Prusick |
First Address | Lexington, KY 40508-3206 |
Second Address | Lexington, KY 40508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2012 |
Last Update Date | 22/08/2019 |