Samuel Lyle Graham III, M.D.
Individual provider Active NPI Internal Medicine Physician · Louisville, KY
NPI 1043376148 · NPPES record last updated Jun 20, 2008
Key facts
- NPI
- 1043376148
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 18158 (KY)
- Practice address
- 1900 Lonlipman CT
Louisville, KY 40207-1732 - Phone
- (502) 897-6039
- NPI assigned
- Dec 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4058 | KY | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Surgical Associates PSC | Past | Accepting new patients | |
| Kentuckiana Pulmonary Associates, PLLC | Past | Accepting new patients | |
| Community Medical Associates, Inc. | Internal Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 18158 | KY | Yes |
| Pulmonary Disease Physician | 207RP1001X | 18158 | KY |
Addresses
Primary practice location
1900 Lonlipman CT
Louisville, KY 40207-1732
Mailing address
1900 Lonlipman CT
Louisville, KY 40207-1732
Phone (502) 897-6039
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 538148 | Other | KY | BCBS |
| 64181589 | Medicaid | KY | |
| 1061538 | Other | KY | PASSPORT |
Other providers in Louisville, KY
- Kevin Alexander Graham
- Kristine Graham
- Mary Elizabeth Graham
- Michael Graham
- Rebecca Marie Graham
- Stephen Lee Graham
- Tamara Graham
- Victoria Graham
- William Clinton Graham
- Erica Don Grahovac
All providers in Louisville, KY · Internal Medicine Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.