| D M Shivakumar M D P S C | |
|
908 S Lincoln Blvd Hodgenville KY 42748-1702 | |
| (270) 358-8650 | |
| (270) 358-0084 |
| Full Name | D M Shivakumar M D P S C |
|---|---|
| Speciality | Internal Medicine |
| Location | 908 S Lincoln Blvd, Hodgenville, Kentucky |
| Authorized Official Name and Position | Doddachallor Matt Shivakumar (PRESIDENT) |
| Authorized Official Contact | 2703588650 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| D M Shivakumar M D P S C 908 S Lincoln Blvd Hodgenville KY 42748-1702 Ph: (270) 358-8650 | D M Shivakumar M D P S C 908 S Lincoln Blvd Hodgenville KY 42748-1702 Ph: (270) 358-8650 |
| NPI Number | 1336470806 |
|---|---|
| Provider Enumeration Date | 01/23/2010 |
| Last Update Date | 09/08/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336470806 | NPI | - | NPPES |
| 64204522 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 20452 (Kentucky) | Primary |
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