Provider Demographics
NPI:1689963589
Name:PATTAR, GURUPRASAD RAVINDRA (MD)
Entity Type:Individual
Prefix:
First Name:GURUPRASAD
Middle Name:RAVINDRA
Last Name:PATTAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 STORY AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1738
Mailing Address - Country:US
Mailing Address - Phone:502-589-1500
Mailing Address - Fax:502-589-1556
Practice Address - Street 1:1536 STORY AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1738
Practice Address - Country:US
Practice Address - Phone:502-589-1500
Practice Address - Fax:502-589-1556
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48596207W00000X
IN01075545A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology