Provider Demographics
NPI:1982691499
Name:VYAS, THOKUR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOKUR
Middle Name:
Last Name:VYAS
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 1:908 DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4602
Mailing Address - Country:US
Mailing Address - Phone:502-749-7909
Mailing Address - Fax:502-222-0029
Practice Address - Street 1:908 DUPONT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4602
Practice Address - Country:US
Practice Address - Phone:502-749-7909
Practice Address - Fax:502-222-0029
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029113A207P00000X
KY19311207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C64280Medicare UPIN