Healthcare Provider Details

I. General information

NPI: 1063554608
Provider Name (Legal Business Name): DR. NAIR INTERNAL MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8442 DIXIE HWY
LOUISVILLE KY
40258-1140
US

IV. Provider business mailing address

8442 DIXIE HWY
LOUISVILLE KY
40258-1140
US

V. Phone/Fax

Practice location:
  • Phone: 502-638-4280
  • Fax: 502-638-4281
Mailing address:
  • Phone: 502-638-4280
  • Fax: 502-638-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number31256
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. SURESH NAIR
Title or Position: OWNER/PROVIDER
Credential: M.D.
Phone: 502-638-4280