Individual
ALLEN LEE CORNISH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-4661
(859) 258-4620
Mailing address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-4661
(859) 258-4620
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
18114
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110055332
RR MEDICARE PIN
GA
01
—
36000818
MEDICAID ASC GROUP
KY
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
05
—
64181142
—
KY
01
—
ASC1019
MEDICARE ASC GROUP
KY
01
—
CB5773
RR MEDICARE GROUP
GA
Enumeration date
07/10/2006
Last updated
01/07/2015
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