Individual
MUTYAM V SHARMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2909 PRESTON HWY, LOUISVILLE, KY 40217
(502) 635-6321
(502) 637-6386
Mailing address
PO BOX 32513, LOUISVILLE, KY 40232
(502) 635-6321
(502) 637-6386
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
17798
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000045870
ANTHEM
KY
01
—
1059052
PASSPORT
KY
05
—
64177983
—
KY
Enumeration date
03/29/2007
Last updated
07/08/2007
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