Individual
SPENCER RYAN IDSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6341 MEETING ST STE 102, PROSPECT, KY 40059-8731
(502) 566-0300
Mailing address
6341 MEETING ST STE 102, PROSPECT, KY 40059-8731
(502) 566-0300
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
49531
KY
208000000X
Pediatrics Physician
49531
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100439060
—
KY
Enumeration date
04/24/2012
Last updated
12/08/2023
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