Individual
MADHUSUDHAN R YAKKANTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3920 DUTCHMANS LN STE 310, LOUISVILLE, KY 40207-4702
(502) 259-6888
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
01075275A
IN
207X00000X
Orthopaedic Surgery Physician
Primary
40767
KY
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
01075275A
IN
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
40767
KY
207XX0801X
Orthopaedic Trauma Physician
01075275A
IN
207XX0801X
Orthopaedic Trauma Physician
40767
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000516385
ANTHEM
KY
05
—
200870310
—
IN
01
—
2851482000
PASSPORT ADVANTAGE
KY
01
—
50015260
PASSPORT
KY
05
—
7100003910
—
KY
01
—
7492940
AETNA
KY
01
—
P00399786
RAIL ROAD MEDICARE
—
01
—
P200468583
RAILROAD MEDICARE UL
KY
Enumeration date
01/03/2007
Last updated
05/14/2024
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