Healthcare Provider Details

I. General information

NPI: 1316125073
Provider Name (Legal Business Name): G. LEWIS SUTHERLAND, D.P.M.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 NICHOLASVILLE RD
LEXINGTON KY
40503-2520
US

IV. Provider business mailing address

2130 NICHOLASVILLE RD
LEXINGTON KY
40503-2520
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-7011
  • Fax: 859-278-2015
Mailing address:
  • Phone: 859-278-7011
  • Fax: 859-278-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number117
License Number StateKY

VIII. Authorized Official

Name: G. LEWIS SUTHERLAND
Title or Position: OWNER
Credential: D.P.M.
Phone: 859-278-7011