Basic Information
| Provider Information | |||||||||
| NPI: | 1003162546 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BISONO JIMENEZ | ||||||||
| FirstName: | INDHIRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407430936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063307840 | ||||||||
| FaxNumber: | 6063307825 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 FOUNTAIN CT | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405092694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8596297265 | ||||||||
| FaxNumber: | 8596297266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2012 | ||||||||
| LastUpdateDate: | 05/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 46770 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RR0500X | 46770 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.