Individual
DR. DODDACHALLOR MATT SHIVAKUMAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.,
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
KY20452
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64204522
—
KY
Enumeration date
01/24/2006
Last updated
09/08/2010
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