Provider Demographics
NPI:1659534170
Name:LYE, ADAM DREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:DREW
Last Name:LYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776347
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6347
Mailing Address - Country:US
Mailing Address - Phone:502-272-5052
Mailing Address - Fax:502-629-6217
Practice Address - Street 1:315 E BROADWAY FL 4
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-629-2884
Practice Address - Fax:502-629-2443
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1549207R00000X
KY43014207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100104910Medicaid
KYK002480Medicare PIN
KY0169Medicare PIN