Individual
MS. LEESA RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3215 WESTPORT GREEN PL, LOUISVILLE, KY 40241-3135
(502) 412-1112
(502) 357-0606
Mailing address
PO BOX 950166, LOUISVILLE, KY 40295-0166
(502) 253-1035
(502) 253-1037
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
22847
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000189835
BCBS
KY
05
—
64224876
—
KY
Enumeration date
07/26/2006
Last updated
10/25/2012
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