Provider Demographics
NPI:1174795181
Name:MEDICAL SPECIALISTS OF KENTUCKIANA
Entity type:Organization
Organization Name:MEDICAL SPECIALISTS OF KENTUCKIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:SAMY
Authorized Official - Last Name:NADAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-533-8888
Mailing Address - Street 1:1013 N DUPONT SQ STE A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4612
Mailing Address - Country:US
Mailing Address - Phone:502-896-6166
Mailing Address - Fax:502-896-6168
Practice Address - Street 1:170 DR ARLA WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-5427
Practice Address - Country:US
Practice Address - Phone:502-896-6166
Practice Address - Fax:502-896-6168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35843207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65940421Medicaid
KY65940421Medicaid