Provider Demographics
NPI:1154826600
Name:BELUR, AGASTYA DEEPAK (MD)
Entity Type:Individual
Prefix:
First Name:AGASTYA
Middle Name:DEEPAK
Last Name:BELUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301, IVORY HEIGHTS CHS, 2ND CROSS ROAD
Mailing Address - Street 2:LOKHANDWALA COMPLEX, ANDHERI (WEST)
Mailing Address - City:MUMBAI
Mailing Address - State:MAHARASHTRA
Mailing Address - Zip Code:400053
Mailing Address - Country:IN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 SOUTH JACKSON STREET
Practice Address - Street 2:AMBULATORY CARE BUILDING, 3RD FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-852-5666
Practice Address - Fax:502-852-8980
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program