Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 40065 | KY |
NPI | 1083771281 |
---|---|
Provider Name | Dr. Bhagyalaxmi Rudravaram |
First Address | Louisville, KY 40241-4863 |
Second Address | Louisville, KY 40202-1622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 08/07/2007 |