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General NPI Number Information
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NPI Number | 1063400885
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Entity Type | Individual
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Provider Name | KODUVATHARA L JAMES MD
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Gender | Male
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 04/02/2018
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Provider Practice Location Address
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Address Line | 225 ABRAHAM FLEXNER WAY SUITE 305
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City | LOUISVILLE
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State | KY
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Zip | 40202-1882
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Country | US
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Telephone | 502-585-4321
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Fax | 502-566-6338
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Provider Business Mailing Address
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Address Line | 100 E LIBERTY ST STE 800
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City | LOUISVILLE
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State | KY
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Zip | 40202-1428
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Country | US
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Telephone | 502-585-4321
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Fax | 502-566-6338
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 01033493A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 23622
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License Number State | KY
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