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Individual

LEE ADAM BALAKLAW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1057 MEADOWBROOK LN, LOUISA, KY 41230-9658
(606) 638-4300
(606) 638-0039
Mailing address
1057 MEADOWBROOK LN, LOUISA, KY 41230-9658
(606) 638-4300
(606) 638-0039

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
29892
KY
207LP2900X
Pain Medicine (Anesthesiology) Physician
042-0008748
VT
207LP2900X
Pain Medicine (Anesthesiology) Physician
29892
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000050355
BLUE CROSS BLUE SHIELD
05
0060588000
WV
05
1019052
VT
01
3257452
CIGNA
05
64298920
KY
Enumeration date
08/31/2005
Last updated
03/13/2013
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