Provider Demographics
NPI:1003162546
Name:BISONO JIMENEZ, INDHIRA (MD)
Entity Type:Individual
Prefix:DR
First Name:INDHIRA
Middle Name:
Last Name:BISONO JIMENEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7840
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:211 FOUNTAIN CT
Practice Address - Street 2:SUITE 220
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2694
Practice Address - Country:US
Practice Address - Phone:859-629-7265
Practice Address - Fax:859-629-7266
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46770207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine