Healthcare Provider Details

I. General information

NPI: 1598225617
Provider Name (Legal Business Name): ELIZABETH LJUBA MIRSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N EAGLE CREEK DR STE 110
LEXINGTON KY
40509-9087
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-263-0141
  • Fax: 859-263-8669
Mailing address:
  • Phone: 606-330-7835
  • Fax: 859-263-8669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number58098
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number59098
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: