Individual
DR. KAVITA SRIDEVI JYOTULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1850 BLUEGRASS AVE, LOUISVILLE, KY 40215-1161
(502) 367-3360
(502) 367-3365
Mailing address
100 E LIBERTY ST STE 800, LOUISVILLE, KY 40202-1428
(502) 367-3360
(502) 367-3365
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
43840
KY
207R00000X
Internal Medicine Physician
57.012678
OH
207R00000X
Internal Medicine Physician
TP390
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201009210
—
IN
05
—
7100102180
—
KY
01
—
P00894830
MEDICARE RR
KY
Enumeration date
08/01/2008
Last updated
03/21/2018
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