Healthcare Provider Details

I. General information

NPI: 1376447201
Provider Name (Legal Business Name): LEXINGTON INTEGRATIVE SPORTS MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 EXECUTIVE DR STE 110
LEXINGTON KY
40505-4810
US

IV. Provider business mailing address

533 SOUTHPOINT DR
LEXINGTON KY
40515-5121
US

V. Phone/Fax

Practice location:
  • Phone: 859-374-3529
  • Fax: 859-994-5736
Mailing address:
  • Phone: 859-374-3529
  • Fax: 859-994-5736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SRIKANTH NITHYANANDAM
Title or Position: MD, OWNER
Credential:
Phone: 859-374-3529