Provider Demographics
NPI:1255383162
Name:NIDHIRY, EMMANUEL ABRAHAM (MD)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:ABRAHAM
Last Name:NIDHIRY
Suffix:
Gender:
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 776347 SUITE 100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-8500
Mailing Address - Country:US
Mailing Address - Phone:502-272-5062
Mailing Address - Fax:859-238-2206
Practice Address - Street 1:4955 NORTON HEALTHCARE BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2832
Practice Address - Country:US
Practice Address - Phone:502-394-6350
Practice Address - Fax:502-394-6351
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41532207RH0003X, 207RX0202X
MDD0057545207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000547932OtherANTHEM BCBS
KY000000547932OtherANTHEM BC/CS
KY000000547932OtherANTHEM
IN300086157Medicaid
207RH0003XOtherUNITED HEALTHCARE
KY7100034410Medicaid
207RH0003XOtherTRICARE
KY87091OtherCOVENTRYCARES OF KENTUCKY
KYC24052OtherCUMBERLAND HEALTHCARE
MD699052500Medicaid