Provider Demographics
NPI:1902883143
Name:KUE, IA Y (DO)
Entity Type:Individual
Prefix:
First Name:IA
Middle Name:Y
Last Name:KUE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 LEE BYRD RD
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-2310
Mailing Address - Country:US
Mailing Address - Phone:707-554-4717
Mailing Address - Fax:770-554-4681
Practice Address - Street 1:115 LEE BYRD RD
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2310
Practice Address - Country:US
Practice Address - Phone:707-554-4717
Practice Address - Fax:770-554-4681
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015717207Q00000X
GA95143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI45-1674932OtherCOMMERCIAL FEIN
MI700H273300OtherBLUE CROSS BLUE SHEILD