Provider Demographics
NPI:1831256023
Name:CORBETT, LEE
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:CORBETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13125 EASTPOINT PARK BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3168
Mailing Address - Country:US
Mailing Address - Phone:502-721-0330
Mailing Address - Fax:502-721-0090
Practice Address - Street 1:13125 EASTPOINT PARK BOULEVARD
Practice Address - Street 2:SUITE 102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223
Practice Address - Country:US
Practice Address - Phone:502-721-0330
Practice Address - Fax:502-721-0090
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33616208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0777501Medicare ID - Type Unspecified
KYG65829Medicare UPIN