Individual
LISA LEIGH CORUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
175 S ENGLISH STATION RD STE 226, LOUISVILLE, KY 40245-4199
(502) 244-0911
(502) 253-0581
Mailing address
11501 REDWOOD WAY, LOUISVILLE, KY 40223-2362
(803) 487-4006
(000) 000-0000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2013-02331
NC
207Q00000X
Family Medicine Physician
33949
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000624358
ANTHEM
KY
05
—
187522
—
SC
01
—
3722989000
PASSPORT ADVANTAGE
KY
01
—
50024464
PASSPORT
KY
05
—
64339492
—
KY
01
—
K204930-KOHMG
MEDICARE
KY
Enumeration date
08/03/2005
Last updated
09/24/2021
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