Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 52287 | KY |
NPI | 1033550298 |
---|---|
Provider Name | Pradeep Kumar Mandya Javarayee |
First Address | Chicago, IL 60677-6879 |
Second Address | Louisville, KY 40202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2013 |
Last Update Date | 26/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100587860 | (05) | KY |