Provider Demographics
NPI:1174527527
Name:KULENOVIC, ELVEDIN (MD)
Entity type:Individual
Prefix:
First Name:ELVEDIN
Middle Name:
Last Name:KULENOVIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21249
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40221-0249
Mailing Address - Country:US
Mailing Address - Phone:502-581-1500
Mailing Address - Fax:502-540-4959
Practice Address - Street 1:530 S JACKSON ST
Practice Address - Street 2:# C07
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1675
Practice Address - Country:US
Practice Address - Phone:502-852-5875
Practice Address - Fax:502-852-1754
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY376972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00125213OtherRAILROAD MEDICARE
KY000000329948OtherANTHEM
KY64076631Medicaid
KY64076631Medicaid
KY0709889Medicare ID - Type Unspecified
KYP00125213OtherRAILROAD MEDICARE