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Organization
KENTUCKY BLUE MEDICAL LLC
Active
Organization
KENTUCKY BLUE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRANSTON SHEPPARD (OWNER)
(502) 361-1159
Entity
Organization
Contact information
Practice address
4602 SOUTHERN PKWY STE 1A, LOUISVILLE, KY 40214-1442
(502) 361-1159
Mailing address
4602 SOUTHERN PKWY STE 1A, LOUISVILLE, KY 40214-1442
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
—
NULL
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
—
—
Other
Enumeration date
06/15/2016
Last updated
06/15/2016
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