Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 35087541 | OH |
N | 111NI0900X | Internist | 35087541 | OH |
Y | 207R00000X | Internist | 42999 | KY |
Y | 111NI0900X | Internist | 42999 | KY |
N | 207RI0200X | Infectious Disease | 42999 | KY |
NPI | 1043263346 |
---|---|
Provider Name | Praveen Seshabhattar |
First Address | Louisville, KY 40258-3913 |
Second Address | Louisville, KY 40215-1161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 19/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201062650 | (05) | IN |
7100154080 | (05) | KY |
PENDING | (02) | OH |
PENDING | (05) | OH |