Individual
DR. DEEPAK SRIVASTAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 SAINT JOSEPH LN, ANESTHESIA PROGRAM, LONDON, KY 40741-8345
(606) 330-6906
(606) 330-6536
Mailing address
100 E LIBERTY ST, SUITE 800, LOUISVILLE, KY 40202-1434
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
31258
KY
207LP2900X
Pain Medicine (Anesthesiology) Physician
31258
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000378136
ANTHEM PROVIDER #
KY
01
—
030670000
BLACK LUNG
KY
01
—
50008010
PASSPORT HEALTH PLAN
KY
01
—
61-1427889
BLUEGRASS FAMILY HEALTH
KY
05
—
64312580
—
KY
01
—
C20833
CUMBERLAND HEALTHCARE INC
KY
01
—
P00281314
RRMCR
KY
Enumeration date
02/14/2006
Last updated
03/30/2017
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