Basic Information
| Provider Information | |||||||||
| NPI: | 1811156870 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FANUCCHI | ||||||||
| FirstName: | LAURA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 S LIMESTONE K512 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360001 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 740 S LIMESTONE | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593235544 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2008 | ||||||||
| LastUpdateDate: | 03/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0401X | 45156 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 208M00000X | 45156 | KY | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 45156 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.