Provider Demographics
NPI:1063400885
Name:JAMES, KODUVATHARA L (MD)
Entity type:Individual
Prefix:
First Name:KODUVATHARA
Middle Name:L
Last Name:JAMES
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 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-585-4321
Mailing Address - Fax:502-566-6338
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:SUITE 305
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1882
Practice Address - Country:US
Practice Address - Phone:502-585-4321
Practice Address - Fax:502-566-6338
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033493A207RC0000X
KY23622207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64756406Medicaid
KYP00141381OtherRAILROAD MEDICARE
IN060026550OtherRAILROAD MEDICARE
IN100075640Medicaid
KY060057271OtherRAILROAD MEDICARE
KY00311003Medicare PIN
KY0690801Medicare PIN
KY00308003Medicare PIN
KY0289318Medicare PIN
IN251440KMedicare PIN
KY1273212Medicare PIN
KY00312003Medicare PIN
KY060057271OtherRAILROAD MEDICARE
KYP00141381OtherRAILROAD MEDICARE
KY0245418Medicare PIN
KY00309003Medicare PIN
KY00313003Medicare PIN
IN060026550OtherRAILROAD MEDICARE
IN100075640Medicaid
KY64756406Medicaid
KY00546059Medicare Oscar/Certification
INM400053593Medicare PIN
KY1600108Medicare PIN