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General NPI Number Information
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NPI Number | 1346214681
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Entity Type | Individual
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Provider Name | DEEPAK SRIVASTAVA M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 1001 SAINT JOSEPH LN ANESTHESIA PROGRAM
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City | LONDON
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State | KY
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Zip | 40741-8345
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Country | US
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Telephone | 606-330-6906
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Fax | 606-330-6536
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Provider Business Mailing Address
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Address Line | 100 E LIBERTY ST SUITE 800
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City | LOUISVILLE
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State | KY
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Zip | 40202-1434
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Country | US
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Telephone |
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 31258
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 31258
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License Number State | KY
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