Organization
LETEK PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS WILLIAM FOWLES M.D. (OWNER)
(859) 358-3069
Entity
Organization
Contact information
Practice address
942 W MAIN ST UNIT B, MOUNT VERNON, KY 40456-2523
(731) 571-9223
(931) 901-1239
Mailing address
942 W MAIN ST UNIT B, MOUNT VERNON, KY 40456-2523
(731) 571-9223
(931) 901-1239
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
38140
KY
261QP2300X
Primary Care Clinic/Center
Primary
38140
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64102726
—
KY
01
—
7846668
AETNA PIN
KY
Enumeration date
08/31/2016
Last updated
03/06/2021
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