Provider Demographics
NPI:1437375839
Name:KISHORE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:KISHORE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JADHAV
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:KISHORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-599-0200
Mailing Address - Street 1:94 MARIE LANGDON DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-6353
Mailing Address - Country:US
Mailing Address - Phone:606-599-0200
Mailing Address - Fax:606-599-0202
Practice Address - Street 1:94 MARIE LANGDON DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-6353
Practice Address - Country:US
Practice Address - Phone:606-599-0200
Practice Address - Fax:606-599-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33372174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYG72766Medicare UPIN
KY7565Medicare ID - Type Unspecified