Individual
SURESH BABU KODALI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
708 WESTPORT RD STE 103, ELIZABETHTOWN, KY 42701-2866
(270) 766-1234
(270) 766-1144
Mailing address
708 WESTPORT RD STE 103, ELIZABETHTOWN, KY 42701-2866
(270) 766-1234
(270) 766-1144
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
24553
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64245533
—
KY
Enumeration date
09/29/2006
Last updated
09/27/2011
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