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General NPI Number Information
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NPI Number | 1306156369
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Entity Type | Organization
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Legal Business Name | MULBERRY INTERNAL MEDICINE PLLC
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 12/22/2010
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Provider Practice Location Address
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Address Line | 2425 REGENCY RD SUITE B
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City | LEXINGTON
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State | KY
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Zip | 40503-2948
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Country | US
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Telephone | 859-275-1248
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Fax | 852-275-1249
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Provider Business Mailing Address
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Address Line | 2425 REGENCY RD SUITE B
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City | LEXINGTON
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State | KY
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Zip | 40503-2948
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Country | US
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Telephone | 859-275-1248
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Fax | 859-275-1249
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Authorized Official
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Title or Position | OWNER
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Name | PENNY MULBERRY
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Credential | MD
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Telephone | 859-275-1248
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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 | 40872
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License Number State | KY
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