Healthcare Provider Details

I. General information

NPI: 1417980608
Provider Name (Legal Business Name): ANANTH NETRAKERE KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 EASTERN BYP MOB 1, SUITE 20
RICHMOND KY
40475-2415
US

IV. Provider business mailing address

789 EASTERN BYP MOB 1, SUITE 20
RICHMOND KY
40475-2415
US

V. Phone/Fax

Practice location:
  • Phone: 859-625-5511
  • Fax: 859-625-5513
Mailing address:
  • Phone: 859-625-5511
  • Fax: 859-625-5513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35405
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35405
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number2080
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: