| NPI | 1417256710 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAINE LISNER Md/Owner 502-426-9200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Additional Taxonomies | 111N00000X Chiropractor |
| 174400000X Specialist | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2021-08-05 |