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NPI Code Detail

MEDICARE: KENNETH MCLEISH MD

MEDICARE: KENNETH MCLEISH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RN0300XNephrology Physician21143KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023099066
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH MCLEISH MD
Provider Business Mailing Address
First Line : 501 E BROADWAY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40202-2043
Country : US
Telephone Number : 502-589-4856
Fax Number : 502-589-5093
Provider Business Practice Location Address
First Line : 615 S PRESTON ST
Second Line :
City : LOUISVILLE
State : KY
Zip : 40202-1715
Country : US
Telephone Number : 502-852-5757
Fax Number : 502-852-7643
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2005
Last Update Date : 07/08/2007

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