Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 31894 | KY |
NPI | 1760576599 |
---|---|
Provider Name | Leon H Kircik |
First Address | Lousiville, KY 40217 |
Second Address | Lousiville, KY 40217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 20/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64318942 | (05) | KY |
F50540 | (02) |