Provider Demographics
NPI:1679329098
Name:PRAVEENKUMAR, RAMYA (MD)
Entity Type:Individual
Prefix:
First Name:RAMYA
Middle Name:
Last Name:PRAVEENKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAMYA
Other - Middle Name:
Other - Last Name:GOVINDARAJU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4402 CHURCHMAN AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-3101
Mailing Address - Country:US
Mailing Address - Phone:502-852-0132
Mailing Address - Fax:
Practice Address - Street 1:4402 CHURCHMAN AVE STE 306
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-3101
Practice Address - Country:US
Practice Address - Phone:502-852-0132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program