Healthcare Provider Details

I. General information

NPI: 1467450601
Provider Name (Legal Business Name): VASUDEVA G. IYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: VASUDEVA G AYYAR MD, DM

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 BUSH RIDGE DR SUITE A
LOUISVILLE KY
40245-5885
US

IV. Provider business mailing address

2505 BUSH RIDGE DR SUITE A
LOUISVILLE KY
40245-5885
US

V. Phone/Fax

Practice location:
  • Phone: 502-708-1338
  • Fax: 502-708-1339
Mailing address:
  • Phone: 502-708-1338
  • Fax: 502-708-1339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number22671
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number22671
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: