Provider Demographics
NPI:1447600622
Name:LAKE CUMBERLAND RHEUMATOLOGY PLLC
Entity Type:Organization
Organization Name:LAKE CUMBERLAND RHEUMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LONESKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-802-2300
Mailing Address - Street 1:3901 DUTCHMANS LANE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4727
Mailing Address - Country:US
Mailing Address - Phone:606-802-2300
Mailing Address - Fax:606-802-2400
Practice Address - Street 1:3901 DUTCHMANS LANE
Practice Address - Street 2:SUITE 202
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4727
Practice Address - Country:US
Practice Address - Phone:606-802-2300
Practice Address - Fax:606-802-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty