Individual
RAGHUNATH GUDIBANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
315 E BROADWAY STE 185E, LOUISVILLE, KY 40202-3700
(502) 629-5455
(502) 629-4151
Mailing address
PO BOX 950202, LOUISVILLE, KY 40295-0202
(502) 969-6552
(502) 969-3799
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
41448
KY
208VP0000X
Pain Medicine Physician
41448
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000587053
ANTHEM/NORTON
KY
01
—
000023033X
HUMANA
KY
01
—
098231
SIHO
KY
05
—
200948520
—
IN
01
—
3552164000
PASSPORT ADVANTAGE
KY
01
—
50021428
PASSPORT
KY
05
—
7100064020
—
KY
Enumeration date
01/31/2007
Last updated
09/10/2009
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