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NPI Code Detail

MEDICARE: KEVIN MICHAEL LEDUE

MEDICARE: KEVIN MICHAEL LEDUE
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
1183500000XPharmacistPR12968ME

General Provider Information

NPI Number : 1942676721
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN MICHAEL LEDUE
Provider Business Mailing Address
First Line : 200 MAPLE ST STE 3
Second Line :
City : CORNISH
State : ME
Zip : 04020-3141
Country : US
Telephone Number : 207-625-8050
Fax Number : 207-625-4628
Provider Business Practice Location Address
First Line : 200 MAPLE ST STE 3
Second Line :
City : CORNISH
State : ME
Zip : 04020-3141
Country : US
Telephone Number : 207-625-8050
Fax Number : 207-625-4628
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2015
Last Update Date : 08/17/2015

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Directions to “ KEVIN MICHAEL LEDUE ” Practice Location

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