Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 53464 | KY |
N | 111NI0900X | Internist | 53464 | KY |
Y | 207RA0201X | Internist - Allergy & Immunology | 53464 | KY |
NPI | 1427432285 |
---|---|
Provider Name | Chandra Vethody |
First Address | Chicago, IL 60677-6879 |
Second Address | Louisville, KY 40202-1713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2015 |
Last Update Date | 29/10/2020 |