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General NPI Number Information
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NPI Number | 1821440082
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Entity Type | Individual
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Provider Name | MADHURA MYLA
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Gender | Female
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Dates
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Enumeration Date | 07/11/2016
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 1301 PLEASANT VALLEY RD STE 202
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City | OWENSBORO
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State | KY
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Zip | 42303-9774
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Country | US
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Telephone | 270-417-7500
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Fax | 270-417-7509
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Provider Business Mailing Address
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Address Line | PO BOX 55310
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City | BIRMINGHAM
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State | AL
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Zip | 35255-5310
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Country | US
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Telephone | 205-731-9701
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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 | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 44455
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | RS2016-0506
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 58933
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License Number State | KY
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