Healthcare Provider Details

I. General information

NPI: 1477074789
Provider Name (Legal Business Name): RUTHVIK SRINIVASAMURTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOSPITAL DR FL PARK11
MADISONVILLE KY
42431-1658
US

IV. Provider business mailing address

800 HOSPITAL DR FL PARK11
MADISONVILLE KY
42431-1658
US

V. Phone/Fax

Practice location:
  • Phone: 270-326-3800
  • Fax: 270-326-3805
Mailing address:
  • Phone: 407-919-5715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number59021
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number59021
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: