Provider Demographics
NPI:1972529550
Name:CHERIAN, PONNATTU K (MD)
Entity Type:Individual
Prefix:
First Name:PONNATTU
Middle Name:K
Last Name:CHERIAN
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 1:6420 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-891-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18183207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000057058ZOtherHUMANA NCVA
KY64181837Medicaid
KY000000693039OtherANTHEM - NCVA
IN100388750AMedicaid
IN100388750FMedicaid
KY1056109OtherPASSPORT PIN
KY000000044895OtherANTHEM PIN
610706398001OtherTRICARE PIN
KY2433835000OtherPASSPORT ADVANTAGE PIN
KYP00889589OtherMEDICARE RR - NCVA
KYP00889589OtherMEDICARE RR - NCVA
KY2433835000OtherPASSPORT ADVANTAGE PIN
IN100388750FMedicaid
KY1271822Medicare PIN