Provider Demographics
NPI:1689758799
Name:AMMISETTY, SRINIVAS M (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:M
Last Name:AMMISETTY
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Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9350 US HWY 23 SOUTH
Mailing Address - Street 2:P O BOX 70
Mailing Address - City:STANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41659
Mailing Address - Country:US
Mailing Address - Phone:606-478-1005
Mailing Address - Fax:606-478-8687
Practice Address - Street 1:9350 US HWY 23 SOUTH
Practice Address - Street 2:SUITE 104
Practice Address - City:STANVILLE
Practice Address - State:KY
Practice Address - Zip Code:41659
Practice Address - Country:US
Practice Address - Phone:606-478-1005
Practice Address - Fax:606-478-8687
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2020-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY35594207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65943516Medicaid
H10165Medicare UPIN
KY1909001Medicare PIN