Healthcare Provider Details

I. General information

NPI: 1437157146
Provider Name (Legal Business Name): DEEPA PRASAD KUDALKAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEEPA J. BALAKRISHNAN

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

379 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

V. Phone/Fax

Practice location:
  • Phone: 513-246-7016
  • Fax: 513-852-3283
Mailing address:
  • Phone: 513-246-7016
  • Fax: 513-852-3283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11197
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number35-092770
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: