Healthcare Provider Details

I. General information

NPI: 1174056238
Provider Name (Legal Business Name): SAMRATH BHIMANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9880 ANGIES WAY STE 205
LOUISVILLE KY
40241-2858
US

IV. Provider business mailing address

13507 RIDGEMOOR DR
PROSPECT KY
40059-7144
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number58180
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number58180
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: