MEDICARE: DR. VASUDEVA G. IYER 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	2084N0600X	Clinical Neurophysiology Physician	22671	KY
2	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	22671	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	:	1467450601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VASUDEVA G. IYER M.D.

Provider Business Mailing Address
First Line	:	2505 BUSH RIDGE DR
Second Line	:	SUITE A
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-5885
Country	:	US
Telephone Number	:	502-708-1338
Fax Number	:	502-708-1339

Provider Business Practice Location Address
First Line	:	2505 BUSH RIDGE DR
Second Line	:	SUITE A
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-5885
Country	:	US
Telephone Number	:	502-708-1338
Fax Number	:	502-708-1339

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	04/03/2014

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