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General NPI Number Information
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NPI Number | 1396739736
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Entity Type | Individual
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Provider Name | LEE ADAM BALAKLAW M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 1057 MEADOWBROOK LN
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City | LOUISA
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State | KY
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Zip | 41230-9658
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Country | US
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Telephone | 606-638-4300
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Fax | 606-638-0039
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Provider Business Mailing Address
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Address Line | 1057 MEADOWBROOK LN
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City | LOUISA
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State | KY
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Zip | 41230-9658
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Country | US
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Telephone | 606-638-4300
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Fax | 606-638-0039
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 29892
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 042-0008748
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 29892
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License Number State | KY
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