Provider Demographics
NPI:1184853590
Name:DEVARAJU KAUNDAR, ARTHI (MD)
Entity type:Individual
Prefix:
First Name:ARTHI
Middle Name:
Last Name:DEVARAJU KAUNDAR
Suffix:
Gender:F
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 950244
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0244
Mailing Address - Country:US
Mailing Address - Phone:502-953-4700
Mailing Address - Fax:502-772-8189
Practice Address - Street 1:4805 SOUTHSIDE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214
Practice Address - Country:US
Practice Address - Phone:502-772-8860
Practice Address - Fax:502-996-8309
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45886207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100242720Medicaid
KYK094331Medicare PIN
KYK094334Medicare PIN
KYK094330Medicare PIN
KY7100242720Medicaid
KYK094336Medicare PIN
KYK094333Medicare PIN
KYK094335Medicare PIN