Individual
IAN LEE PROVANCHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 ROSE ST, LEXINGTON, KY 40536-7001
(859) 323-2222
(859) 323-5090
Mailing address
475 SEAVIEW AVE, STATEN ISLAND, NY 10305
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
58136
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/17/2018
Last updated
06/06/2024
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