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General NPI Number Information
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NPI Number | 1639275191
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Entity Type | Organization
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Legal Business Name | BLUEGRASS NEUROLOGY, PLLC
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 03/29/2010
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Provider Practice Location Address
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Address Line | 1169 EASTERN PKWY SUITE 1226
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City | LOUISVILLE
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State | KY
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Zip | 40217-1417
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Country | US
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Telephone | 502-454-5044
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Fax | 502-452-9549
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Provider Business Mailing Address
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Address Line | 1169 EASTERN PKWY SUITE 1226
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City | LOUISVILLE
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State | KY
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Zip | 40217-1417
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Country | US
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Telephone | 502-454-5044
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Fax | 502-452-9549
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. RUKMAIAH BHUPALAM
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Credential | MD
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Telephone | 502-454-5044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 23966
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License Number State | KY
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