Provider Demographics
NPI:1417040742
Name:GEEVARGHESE, KUNNATHU P (MD)
Entity Type:Individual
Prefix:DR
First Name:KUNNATHU
Middle Name:P
Last Name:GEEVARGHESE
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 1:4402 CHURCHMAN AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1190
Mailing Address - Country:US
Mailing Address - Phone:502-366-7317
Mailing Address - Fax:502-366-7318
Practice Address - Street 1:4402 CHURCHMAN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1190
Practice Address - Country:US
Practice Address - Phone:502-366-7317
Practice Address - Fax:502-366-7318
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16440207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1131109OtherPASSPORT
050078005OtherMEDICARE RAILROAD
C3647401OtherHUMANA
000000187640OtherKY STATE DISTRICT CO
000000187640OtherONE NATION BENEFIT
40090988000OtherCOMP MANAGEMENT
KY64164403Medicaid
2437681000OtherPASSPORT ADVANTAGE
000000187640OtherANTHEM BCBS
0004012479OtherAETNA
000000187460OtherUNICARE
000000187640OtherKY ACCESS
64164403OtherKENPAC
KY0768901Medicare ID - Type Unspecified
000000187640OtherKY ACCESS