Provider Demographics
NPI:1346266640
Name:THIRKANNAD, SUNIL MANJUNATH (MD)
Entity Type:Individual
Prefix:
First Name:SUNIL
Middle Name:MANJUNATH
Last Name:THIRKANNAD
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 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0328
Mailing Address - Fax:
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY STE 700
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3868
Practice Address - Country:US
Practice Address - Phone:502-561-4263
Practice Address - Fax:502-561-4288
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062221A207XS0106X
KY40209207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64128986Medicaid
IN200847760Medicaid
IN218440TMedicare ID - Type Unspecified
IN200847760Medicaid
INP00415088Medicare PIN
KY64128986Medicaid