Individual
JUSTIN B SEDLAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
290 BIG RUN RD, LEXINGTON, KY 40503-2903
(859) 278-9513
Mailing address
290 BIG RUN RD, LEXINGTON, KY 40503-2903
(859) 278-9513
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
30321
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000044324
BCBS PROVIDER NUMBER
—
01
—
000000804466
BCBS- MMC/POWDERLY CLINIC
KY
01
—
30321
LICENSE
KY
05
—
64303217
—
KY
Enumeration date
09/17/2006
Last updated
03/05/2021
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