Provider Demographics
NPI:1356592968
Name:BOW, LESLEY KYLE (MD)
Entity type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:KYLE
Last Name:BOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 S SEMORAN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2472
Mailing Address - Country:US
Mailing Address - Phone:407-203-8957
Mailing Address - Fax:
Practice Address - Street 1:484 TOLLAGE CRK
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3305
Practice Address - Country:US
Practice Address - Phone:606-230-2255
Practice Address - Fax:606-437-3001
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110633208000000X
KY54953208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004431700Medicaid
WV1356592968Medicaid
VA1356592968Medicaid
KY7100713440Medicaid