MEDICARE: SHARAT KOUL DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	036-112052	IL
2	207RC0000X	Cardiovascular Disease Physician	03108	KY
3	207RI0011X	Interventional Cardiology Physician	064127	GA
4	207RI0011X	Interventional Cardiology Physician	03108	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093986614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARAT KOUL DO

Provider Business Mailing Address
First Line	:	PO BOX 936
Second Line	:
City	:	LONDON
State	:	KY
Zip	:	40743-0936
Country	:	US
Telephone Number	:	606-330-7835
Fax Number	:	859-330-7825

Provider Business Practice Location Address
First Line	:	1250 KEENE RD STE 102
Second Line	:
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-7600
Country	:	US
Telephone Number	:	859-276-4429
Fax Number	:	859-276-4429

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2008
Last Update Date	:	12/08/2022

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Directions to “ SHARAT KOUL DO” Practice Location

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