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General NPI Number Information
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NPI Number | 1174524821
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Entity Type | Individual
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Provider Name | LISA LEIGH CORUM MD
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Gender | Female
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Dates
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Enumeration Date | 08/03/2005
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 175 S ENGLISH STATION RD STE 226
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City | LOUISVILLE
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State | KY
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Zip | 40245-4199
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Country | US
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Telephone | 502-244-0911
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Fax | 502-253-0581
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Provider Business Mailing Address
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Address Line | 11501 REDWOOD WAY
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City | LOUISVILLE
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State | KY
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Zip | 40223-2362
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Country | US
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Telephone | 803-487-4006
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Fax | --
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 33949
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2013-02331
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License Number State | NC
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