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1518283993

NPI Code Detail

MEDICARE: AMBICA MANJUNATH TUMKUR MD

MEDICARE: AMBICA MANJUNATH TUMKUR MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2084N0600X	Clinical Neurophysiology Physician	50099	KY
3	2084N0400X	Neurology Physician	ME123581	FL

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	150NE	OTHER	FL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518283993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBICA MANJUNATH TUMKUR MD

Provider Business Mailing Address
First Line	:	PO BOX 776351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6879
Country	:	US
Telephone Number	:	502-558-9490
Fax Number	:	502-272-5116

Provider Business Practice Location Address
First Line	:	4915 NORTON HEALTHCARE BLVD STE 301
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-2866
Country	:	US
Telephone Number	:	502-394-6460
Fax Number	:	502-394-6465

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

Provider Enumeration Date	:	04/11/2010
Last Update Date	:	03/12/2026

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Directions to “ AMBICA MANJUNATH TUMKUR MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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