Provider Demographics
NPI:1881627859
Name:KUDRIMOTI, MAHESH RAVINDRA (MD)
Entity type:Individual
Prefix:
First Name:MAHESH
Middle Name:RAVINDRA
Last Name:KUDRIMOTI
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 636324
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6324
Mailing Address - Country:US
Mailing Address - Phone:859-301-2238
Mailing Address - Fax:859-301-4946
Practice Address - Street 1:17525 GREENDALE PLAZA DR
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:IN
Practice Address - Zip Code:47025-8299
Practice Address - Country:US
Practice Address - Phone:859-301-2238
Practice Address - Fax:859-301-4946
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY360142085R0001X, 2085R0203X
IN01090145A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64034028Medicaid
KY64034028Medicaid
H40943Medicare UPIN