Provider Demographics
NPI:1568733368
Name:CESARZ, MICHELE LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNN
Last Name:CESARZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BANK ST
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-3545
Mailing Address - Country:US
Mailing Address - Phone:270-756-1700
Mailing Address - Fax:270-756-6205
Practice Address - Street 1:112 BANK ST
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-3545
Practice Address - Country:US
Practice Address - Phone:270-756-1700
Practice Address - Fax:270-756-6205
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0114247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other