Provider Demographics
NPI:1417980608
Name:KUMAR, ANANTH NETRAKERE (MD)
Entity Type:Individual
Prefix:
First Name:ANANTH
Middle Name:NETRAKERE
Last Name:KUMAR
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 1:789 EASTERN BYP
Mailing Address - Street 2:MOB 1, SUITE 20
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2415
Mailing Address - Country:US
Mailing Address - Phone:859-625-5511
Mailing Address - Fax:859-625-5513
Practice Address - Street 1:789 EASTERN BYP
Practice Address - Street 2:MOB 1, SUITE 20
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2415
Practice Address - Country:US
Practice Address - Phone:859-625-5511
Practice Address - Fax:859-625-5513
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35405207RC0000X, 207RI0011X
KY2080207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64006166Medicaid
KY64006166Medicaid
KY0773205Medicare ID - Type Unspecified