Individual
SATHYENDRA R MYSORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 SAINT JOSEPH LN, LONDON, KY 40741-8345
(606) 330-6000
(606) 330-7825
Mailing address
740 E LAUREL RD, LONDON, KY 40741-8601
(606) 877-3931
(606) 877-3978
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
36943
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000378002
ANTHEM PROVIDER #
KY
01
—
030670000
BLACK LUNG
KY
01
—
50005320
PASSPORT HEALTH PLAN
KY
01
—
61-1427889
CHA
KY
05
—
64060783
—
KY
01
—
C20852
CUMBERLAND HEALTHCARE INC
KY
Enumeration date
02/14/2006
Last updated
01/22/2013
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