1902821739 NPI number — ANILKUMAR N VINAYAKAN MD

Table of content: ANILKUMAR N VINAYAKAN MD (NPI 1902821739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902821739 NPI number — ANILKUMAR N VINAYAKAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VINAYAKAN
Provider First Name:
ANILKUMAR
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902821739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-6351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-588-9490
Provider Business Mailing Address Fax Number:
502-272-5116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 E BROADWAY STE 185-E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-629-5455
Provider Business Practice Location Address Fax Number:
502-629-4151
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  38717 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: 38717 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00533130 . This is a "MEDICARE - KY - NNS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50023844 . This is a "PASSPORT - NNS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00726826 . This is a "RR MCR KY - NNS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 104597 . This is a "SIHO - NNS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000615042 . This is a "ANTHEM - NNS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000023036L . This is a "HUMANA - NNS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200493420 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64085335 . This is a "MEDICAID-KY - NNS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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