Provider Demographics
NPI:1982929048
Name:KISHORE, SARITA ANISHA (PHD, MD)
Entity Type:Individual
Prefix:DR
First Name:SARITA
Middle Name:ANISHA
Last Name:KISHORE
Suffix:
Gender:F
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 LELAND RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2006
Mailing Address - Country:US
Mailing Address - Phone:585-455-9764
Mailing Address - Fax:
Practice Address - Street 1:1970 TOLUKA WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-8547
Practice Address - Country:US
Practice Address - Phone:585-455-9764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IDMR-1138207R00000X
KYR2522207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine