Individual
MALLIKARJUN KAMISHETTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
114 N MAIN ST STE 200, SUFFOLK, VA 23434-4564
(757) 983-8600
Mailing address
PO BOX 55, HOPKINSVILLE, KY 42241-0055
(270) 887-0100
(270) 887-0342
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
39952
KY
208M00000X
Hospitalist Physician
39952
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000559181
ANTHEM BCBS
KY
05
—
64129414
—
KY
Enumeration date
06/09/2006
Last updated
02/27/2025
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