Provider Demographics
NPI:1174688683
Name:NAGENDRA, ANEGUNDI K (MD)
Entity Type:Individual
Prefix:
First Name:ANEGUNDI
Middle Name:K
Last Name:NAGENDRA
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-212-0497
Mailing Address - Fax:812-577-0791
Practice Address - Street 1:272 BIELBY RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1056
Practice Address - Country:US
Practice Address - Phone:859-212-0497
Practice Address - Fax:812-577-0791
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17471208800000X
IN01087838A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
34BDBRJMedicare ID - Type Unspecified
D30315Medicare UPIN