Provider Demographics
NPI:1225269350
Name:MENON, NANDINI (MD)
Entity Type:Individual
Prefix:DR
First Name:NANDINI
Middle Name:
Last Name:MENON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6400 DUTCHMANS PKWY STE 125
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3342
Mailing Address - Country:US
Mailing Address - Phone:502-896-8700
Mailing Address - Fax:502-896-0813
Practice Address - Street 1:5202 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-2722
Practice Address - Country:US
Practice Address - Phone:502-896-8700
Practice Address - Fax:502-896-0813
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY51532207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42887801Medicaid
IN656540HMedicare Oscar/Certification