Healthcare Provider Details

I. General information

NPI: 1407012040
Provider Name (Legal Business Name): DR. KEERTHANA KALENGADA KARUMBAIAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 GLENNDALE RD SUITE 2
MANCHESTER KY
40962-6212
US

IV. Provider business mailing address

509 MEMORIAL DR SUITE 2
MANCHESTER KY
40962-6195
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-4500
  • Fax: 606-599-2540
Mailing address:
  • Phone: 606-598-5104
  • Fax: 606-598-0983

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 Number47163
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberR1056
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: