Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 2019033642 | MO |
NPI | 1043866155 |
---|---|
Provider Name | Alok Ravindra Amraotkar |
First Address | Louisville, KY 40202 |
Second Address | Louisville, KY 40202-1622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2019 |
Last Update Date | 21/03/2020 |