MEDICARE: LINNIE S LEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1205114220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINNIE S LEE

Provider Business Mailing Address
First Line	:	409 SOUTHLAND DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1826
Country	:	US
Telephone Number	:	859-294-4343
Fax Number	:	859-402-0905

Provider Business Practice Location Address
First Line	:	409 SOUTHLAND DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1826
Country	:	US
Telephone Number	:	859-294-4343
Fax Number	:	859-402-0905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2011
Last Update Date	:	07/25/2011

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Directions to “ LINNIE S LEE ” Practice Location

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