Individual
JYOTHI MATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
411 E CHESTNUT ST # 5A, LOUISVILLE, KY 40202-1713
(502) 588-7450
(502) 588-7728
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
43892
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036115369 1
—
IL
05
—
200998450
—
IN
05
—
7100127790
—
KY
Enumeration date
08/08/2006
Last updated
03/26/2024
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