Provider Demographics
NPI:1467450601
Name:IYER, VASUDEVA G (MD)
Entity Type:Individual
Prefix:DR
First Name:VASUDEVA
Middle Name:G
Last Name:IYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VASUDEVA
Other - Middle Name:G
Other - Last Name:AYYAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, DM
Mailing Address - Street 1:2505 BUSH RIDGE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5885
Mailing Address - Country:US
Mailing Address - Phone:502-708-1338
Mailing Address - Fax:502-708-1339
Practice Address - Street 1:2505 BUSH RIDGE DR
Practice Address - Street 2:SUITE A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5885
Practice Address - Country:US
Practice Address - Phone:502-708-1338
Practice Address - Fax:502-708-1339
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY226712084N0600X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64226715Medicaid
KY64226715Medicaid
KYB04088Medicare UPIN