Basic Information
| Provider Information | |||||||||
| NPI: | 1740627108 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LALLY | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 S JACKSON ST | ||||||||
| Address2: | ACB, 3RD FLOOR MEDICINE OFFICE | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028525666 | ||||||||
| FaxNumber: | 5028528980 | ||||||||
| Practice Location | |||||||||
| Address1: | 3532 EPHRAIM MCDOWELL DR | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024566200 | ||||||||
| FaxNumber: | 5024566655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2013 | ||||||||
| LastUpdateDate: | 06/08/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0002X | 49076 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 207R00000X | 49076 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.