Provider Demographics
NPI:1437157146
Name:KUDALKAR, DEEPA PRASAD (MD)
Entity type:Individual
Prefix:
First Name:DEEPA
Middle Name:PRASAD
Last Name:KUDALKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEEPA
Other - Middle Name:J
Other - Last Name:BALAKRISHNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:379 DIXMYTH AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2475
Mailing Address - Country:US
Mailing Address - Phone:513-246-7016
Mailing Address - Fax:513-852-3283
Practice Address - Street 1:379 DIXMYTH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:513-246-7016
Practice Address - Fax:513-852-3283
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11197207R00000X
OH35-092770207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100287660OtherMEDICAID
OH760174OtherBUCKEYE - MEDICAID
OHH110400OtherMEDICARE
OH2980181OtherMEDICAID
OH699435OtherBUCKEYE - MEDICARE
OH737691OtherANTHEM
OH7708721OtherAETNA
OHP01107611OtherRAILROAD MEDICARE