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General NPI Number Information
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NPI Number | 1811969298
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Entity Type | Individual
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Provider Name | WILFRED AMISCUA LUMBANG MD
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Gender | Male
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 1065 ASHLEY ST
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City | BOWLING GREEN
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State | KY
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Zip | 42103-3400
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Country | US
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Telephone | 270-843-3376
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Fax | 270-780-0496
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Provider Business Mailing Address
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Address Line | 201 PARK ST
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City | BOWLING GREEN
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State | KY
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Zip | 42101-1708
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Country | US
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Telephone |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD0000045837
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 48569
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 48569
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License Number State | KY
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