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General NPI Number Information
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NPI Number | 1225200462
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Entity Type | Individual
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Provider Name | PHONESAVANE LIANEKHAMMY M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 02/11/2010
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Provider Practice Location Address
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Address Line | 3118 EAST 10TH STREET NORTON COMMUNITY MEDICAL ASSOCIATES
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130
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Country | US
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Telephone | 812-282-6979
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 950202
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City | LOUISVILLE
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State | KY
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Zip | 40295-0202
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Country | US
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Telephone | 502-969-6552
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Fax | 502-969-3799
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | TP138
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 99033592A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | BU6476407R519
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD0000043766
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License Number State | TN
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