Provider Demographics
NPI:1679662258
Name:THIRKANNAD, INDIRA S (MD)
Entity Type:Individual
Prefix:DR
First Name:INDIRA
Middle Name:S
Last Name:THIRKANNAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:234 E GRAY ST STE 766
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1901
Mailing Address - Country:US
Mailing Address - Phone:502-583-7337
Mailing Address - Fax:502-584-5437
Practice Address - Street 1:234 E GRAY ST STE 766
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1901
Practice Address - Country:US
Practice Address - Phone:502-583-7337
Practice Address - Fax:502-584-5437
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY404252086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY40425OtherSTATE LICENSE