Provider Demographics
NPI:1629070214
Name:LE, MICHELLE PHUONG (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:PHUONG
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:804 SCOTT NIXON MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2464
Mailing Address - Country:US
Mailing Address - Phone:800-394-4445
Mailing Address - Fax:
Practice Address - Street 1:233 E GRAY ST
Practice Address - Street 2:SUITE 804, MED TOWER
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2026
Practice Address - Country:US
Practice Address - Phone:502-629-2880
Practice Address - Fax:502-629-2879
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY38891207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INI 18639Medicare UPIN