Healthcare Provider Details

I. General information

NPI: 1780942623
Provider Name (Legal Business Name): MEHUL AJAY SUTHAR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2012
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

793 EASTERN BYP STE 201
RICHMOND KY
40475-2440
US

IV. Provider business mailing address

230 LEXINGTON GREEN CIR STE 600
LEXINGTON KY
40503-3326
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-6560
  • Fax: 859-624-6569
Mailing address:
  • Phone: 859-971-4695
  • Fax: 859-971-4604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number03858
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: