Provider Demographics
NPI:1902821739
Name:VINAYAKAN, ANILKUMAR N (MD)
Entity Type:Individual
Prefix:
First Name:ANILKUMAR
Middle Name:N
Last Name:VINAYAKAN
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 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:315 E BROADWAY STE 185-E
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3700
Practice Address - Country:US
Practice Address - Phone:502-629-5455
Practice Address - Fax:502-629-4151
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38717207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00533130OtherMEDICARE - KY - NNS
KY50023844OtherPASSPORT - NNS
KYP00726826OtherRR MCR KY - NNS
KY104597OtherSIHO - NNS
KY000000615042OtherANTHEM - NNS
KY000023036LOtherHUMANA - NNS
IN200493420Medicaid
KY64085335OtherMEDICAID-KY - NNS
IN196290LLLLMedicare PIN
KY9932873OtherCIGNA - NIS
IN196290LLLLMedicare PIN