Individual
HARINI CHENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
530 S JACKSON ST, LOUISVILLE, KY 40202
(502) 852-5851
(502) 852-3762
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0330
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
50599
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300018871
—
IN
01
—
50599
LICENSE
KY
05
—
7100307140
—
KY
01
—
K272370
MEDICARE
KY
Enumeration date
04/03/2013
Last updated
10/23/2018
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