Provider Demographics
NPI:1366590077
Name:DWIVEDI, SUNITA A (MD)
Entity type:Individual
Prefix:
First Name:SUNITA
Middle Name:A
Last Name:DWIVEDI
Suffix:
Gender:F
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 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:9880 ANGIES WAY STE 420
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2850
Practice Address - Country:US
Practice Address - Phone:502-629-5400
Practice Address - Fax:502-629-5492
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40315207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000503165OtherANTHEM- NORTON CMA
KY000023027NOtherHUMANA- NORTON CMA
IN200848320Medicaid
KYP00415209OtherRAILROAD MEDICARE- NORTON CMA
KY50014624OtherPASSPORT- NORTON CMA
KY2838694000OtherPASSPORT ADVANTAGE- NORTON CMA
KY64130784Medicaid
KYI67180Medicare UPIN
KY2838694000OtherPASSPORT ADVANTAGE- NORTON CMA