Provider Demographics
NPI:1851347819
Name:LEPORA, NICK (DO)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:LEPORA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 950112
Mailing Address - Street 2:DEPT 52387
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0112
Mailing Address - Country:US
Mailing Address - Phone:866-965-3774
Mailing Address - Fax:781-276-6411
Practice Address - Street 1:913 N DIXIE AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2503
Practice Address - Country:US
Practice Address - Phone:877-783-6257
Practice Address - Fax:859-514-5521
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-07-19
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Provider Licenses
StateLicense IDTaxonomies
KY03627207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11281846OtherCAQH
KY000000829738OtherBCBS
MI1851347819Medicaid
KY7100256490Medicaid
KY000000829738OtherBCBS