Organization
LEE W RICKETTS II MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEE W RICKETTS II MD (PHYSICIAN OWNER)
(859) 294-0077
Entity
Organization
Contact information
Practice address
1782 BRYAN STATION ROAD, LEXINGTON, KY 40505
(859) 294-0077
(859) 294-0078
Mailing address
1782 BRYAN STATION ROAD, LEXINGTON, KY 40505
(859) 294-0077
(859) 294-0078
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
30881
KY
208000000X
Pediatrics Physician
30881
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000308817
ANTHEM
KY
01
—
0791601
MEDICARE INDIVIDUAL
KY
05
—
64308810
—
KY
Enumeration date
12/19/2007
Last updated
12/19/2007
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