Pinelake Physician Practice LLC

NPI #1912216532 in Mayfield, Kentucky

Provider Information

NPI Number: 1912216532
Entity Type: Organization
Organization Name: Pinelake Physician Practice LLC
Primary Specialty: Family Medicine
Enumeration Date: Sep 30, 2010
Last Updated: Sep 30, 2010

Practice Location

Address: 1111 MEDICAL CENTER CIR
City: Mayfield
State: Kentucky
ZIP Code: 42066-1194
Phone: (270) 251-4085

Authorized Official

Name: MR. DENIS MILLER
Title: REGIONAL DIRECTOR
Phone: (615) 934-1454

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine - Sports Medicine — Sports Medicine	207QS0010X
Family Medicine	207Q00000X	Primary

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