Provider Demographics
NPI:1386683167
Name:NIGAM, KUSUM T (MD)
Entity type:Individual
Prefix:
First Name:KUSUM
Middle Name:T
Last Name:NIGAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4402 CHURCHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1190
Mailing Address - Country:US
Mailing Address - Phone:502-367-6322
Mailing Address - Fax:502-380-3843
Practice Address - Street 1:200 E CHESTNUT ST BLDG SUITE303
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-5552
Practice Address - Fax:502-629-3137
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY32516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64030026Medicaid
KY64030026Medicaid
KY0937401Medicare ID - Type Unspecified