Healthcare Provider Details

I. General information

NPI: 1295149532
Provider Name (Legal Business Name): LEE MCCADE RIDDLE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2014
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 STATE ST
NEW ALBANY IN
47150-4990
US

IV. Provider business mailing address

350 HOSPITAL WAY STE 101
SOMERSET KY
42503-2872
US

V. Phone/Fax

Practice location:
  • Phone: 812-944-7701
  • Fax: 812-981-6505
Mailing address:
  • Phone: 606-451-5092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04005
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number02005066A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: