Provider Demographics
NPI:1821109513
Name:NATHOO, NARENDRA (MD)
Entity Type:Individual
Prefix:
First Name:NARENDRA
Middle Name:
Last Name:NATHOO
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:PO BOX 2697
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-7697
Mailing Address - Country:US
Mailing Address - Phone:270-745-1100
Mailing Address - Fax:270-745-1156
Practice Address - Street 1:825 2ND AVE
Practice Address - Street 2:SUITE C3
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1786
Practice Address - Country:US
Practice Address - Phone:270-780-2660
Practice Address - Fax:270-780-2692
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44459207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100174900Medicaid
IAI5707Medicare PIN
IAP00309940Medicare PIN
NEI41528Medicare UPIN
KYK008510Medicare PIN
NEP00309940Medicare PIN