Basic Information
| Provider Information | |||||||||
| NPI: | 1295761351 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAPUENTE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9800 SHELBYVILLE RD | ||||||||
| Address2: | STE 220 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402232992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024298585 | ||||||||
| FaxNumber: | 8556567325 | ||||||||
| Practice Location | |||||||||
| Address1: | 6401 POPLAR AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381194810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009991249 | ||||||||
| FaxNumber: | 8556567325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | E14123 | AR | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207K00000X | 4281 | TN | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 008930 | 05 | SC | MEDICAID | 01284 | 01 | NC | BCBS | OTHER | 5900536 | 05 | NC | MEDICAID |