Healthcare Provider Details

I. General information

NPI: 1790718872
Provider Name (Legal Business Name): PREETHI ANANTHAKRISHNAN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 NORTON HEALTHCARE BLVD STE 303
LOUISVILLE KY
40241-2848
US

IV. Provider business mailing address

PO BOX 950202
LOUISVILLE KY
40295-0202
US

V. Phone/Fax

Practice location:
  • Phone: 502-394-6470
  • Fax: 502-394-6477
Mailing address:
  • Phone: 502-272-5100
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number231969-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number42772
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: