Provider Demographics
NPI:1083702062
Name:LUA-CANBY, ARLYN E (MD)
Entity Type:Individual
Prefix:
First Name:ARLYN
Middle Name:E
Last Name:LUA-CANBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:150 FRANKFORT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-9433
Practice Address - Country:US
Practice Address - Phone:502-647-5468
Practice Address - Fax:502-647-7134
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY295962080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYF47237Medicare UPIN