Most Relevant Information
Provider Data
| NPI Number: | 1003510033 |
| Provider Name: | MISA ITO MD PHD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/27/2023 |
| Last Updated: | 03/27/2023 |
Provider Practice Location
900 S LIMESTONE CTW 304
LEXINGTON
KY
405360001
Practice Location Phone/Fax
| Phone: | 8593236561 |
| Fax: |
Provider Mailing Location
165 PENMOKEN PARK
LEXINGTON
KY
405031917
Provider Mailing Phone/Fax
| Phone: | 8592278402 |
| Fax: |