Provider Demographics
NPI:1346739109
Name:MARSILI, BRADFORD LEE
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:LEE
Last Name:MARSILI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:LYNCH
Mailing Address - State:KY
Mailing Address - Zip Code:40855-0035
Mailing Address - Country:US
Mailing Address - Phone:606-273-2049
Mailing Address - Fax:
Practice Address - Street 1:530 S JACKSON ST FL 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1675
Practice Address - Country:US
Practice Address - Phone:502-852-5851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY05628207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300081467Medicaid
KY7100910870Medicaid