Healthcare Provider Details

I. General information

NPI: 1497776397
Provider Name (Legal Business Name): MEDICAL SPECIALISTS OF KENTUCKIANA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 03/12/2022
Certification Date: 03/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 DUPONT SQUARE NORTH STE A
LOUISVILLE KY
40207
US

IV. Provider business mailing address

1013 DUPONT SQUARE NORTH STE A
LOUISVILLE KY
40207
US

V. Phone/Fax

Practice location:
  • Phone: 502-896-6166
  • Fax: 502-896-6168
Mailing address:
  • Phone: 502-896-6166
  • Fax: 502-896-6168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36216
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35843
License Number StateKY

VIII. Authorized Official

Name: DR. VANI NADAR
Title or Position: OWNER
Credential: MD
Phone: 502-896-6166