MEDICARE: DEEPA PRASAD KUDALKAR M.D.

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	207R00000X	Internal Medicine Physician	11197	NV
2	207RR0500X	Rheumatology Physician	35-092770	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	H110400	OTHER	OH	MEDICARE
5	699435	OTHER	OH	BUCKEYE - MEDICARE
8	P01107611	OTHER	OH	RAILROAD MEDICARE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	737691	OTHER	OH	ANTHEM
7	7708721	OTHER	OH	AETNA

General Provider Information

NPI Number	:	1437157146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEPA PRASAD KUDALKAR M.D.

Provider Business Mailing Address
First Line	:	379 DIXMYTH AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-2475
Country	:	US
Telephone Number	:	513-246-7016
Fax Number	:	513-852-3283

Provider Business Practice Location Address
First Line	:	379 DIXMYTH AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-2475
Country	:	US
Telephone Number	:	513-246-7016
Fax Number	:	513-852-3283

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/30/2024

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Directions to “ DEEPA PRASAD KUDALKAR M.D.” Practice Location

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