Provider Demographics
NPI:1700880309
Name:LEBUHN, CARL B (MD)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:B
Last Name:LEBUHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1903 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7105
Mailing Address - Country:US
Mailing Address - Phone:270-444-9889
Mailing Address - Fax:270-444-9291
Practice Address - Street 1:1903 BROADWAY
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7105
Practice Address - Country:US
Practice Address - Phone:270-444-9889
Practice Address - Fax:270-444-9291
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35911207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000282523OtherANTHEM BCBS
KY35911OtherKY LICENSE
KY64026107Medicaid
KY64026107Medicaid
KY35911OtherKY LICENSE