Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 01046741A | IN |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 28777 | KY |
NPI | 1033156328 |
---|---|
Provider Name | Sri Prakash L Mokshagundam |
First Address | Louisville, KY 40202-5700 |
Second Address | Louisville, KY 40202-5700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 16/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200058880 | (05) | IN |
64287774 | (05) | KY |
D56647 | (02) |