Individual
INDU SHIVARAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
245 FLEMINGSBURG RD, MOREHEAD, KY 40351-1015
(606) 780-5500
(606) 780-5512
Mailing address
245 FLEMINGSBURG RD, MOREHEAD, KY 40351-1015
(606) 780-5500
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101265411
VA
207R00000X
Internal Medicine Physician
176776
NY
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
176776
NY
207RP1001X
Pulmonary Disease Physician
176776
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57647
MED LICENSE
KY
05
—
7100905520
—
KY
Enumeration date
09/29/2006
Last updated
10/18/2023
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