Provider Demographics
NPI:1538140165
Name:SREEKUMAR, BHASKARAN N (MD)
Entity type:Individual
Prefix:DR
First Name:BHASKARAN
Middle Name:N
Last Name:SREEKUMAR
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 1:200 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 MCCOY AVE
Practice Address - Street 2:SUITE 379
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2867
Practice Address - Country:US
Practice Address - Phone:270-821-0677
Practice Address - Fax:270-821-2539
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY33663207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64336639Medicaid
F80648Medicare UPIN
0629101Medicare ID - Type Unspecified
KY0935363Medicare PIN
KYK131730Medicare PIN