Individual
DR. SAMUEL LYLE GRAHAM III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1900 LONLIPMAN CT, LOUISVILLE, KY 40207-1732
(502) 897-6039
Mailing address
1900 LONLIPMAN CT, LOUISVILLE, KY 40207-1732
(502) 897-6039
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
18158
KY
207RP1001X
Pulmonary Disease Physician
18158
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1061538
PASSPORT
KY
01
—
538148
BCBS
KY
05
—
64181589
—
KY
Enumeration date
12/31/2006
Last updated
06/20/2008
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