Organization
D M SHIVAKUMAR M D P S C
Active
Organization
D M SHIVAKUMAR M D P S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DODDACHALLOR MATT SHIVAKUMAR M D (PRESIDENT)
(270) 358-8650
Entity
Organization
Contact information
Practice address
908 S LINCOLN BLVD, HODGENVILLE, KY 42748-1702
(270) 358-8650
(270) 358-0084
Mailing address
908 S LINCOLN BLVD, HODGENVILLE, KY 42748-1702
(270) 358-8650
(270) 358-0084
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20452
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64204522
—
KY
Enumeration date
01/23/2010
Last updated
09/08/2010
Update your record
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