Basic Information
| Provider Information | |||||||||
| NPI: | 1801113071 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LESTER S DUPLECHAN MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 THOMAS MORE PKWY | ||||||||
| Address2: | STE 190 | ||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593414842 | ||||||||
| FaxNumber: | 5137931032 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 THOMAS MORE PKWY | ||||||||
| Address2: | STE 190 | ||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593414842 | ||||||||
| FaxNumber: | 8593414845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2010 | ||||||||
| LastUpdateDate: | 03/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | DUPLECHAN | ||||||||
| AuthorizedOfficialFirstName: | LESTER | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8593414842 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 208100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 3074944 | 05 | OH | MEDICAID | DR2194 | 01 | KY | RR MEDICARE | OTHER |