Basic Information
| Provider Information | |||||||||
| NPI: | 1174047245 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KATRAGADDA | ||||||||
| FirstName: | KARTIK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14819 LANDMARK DR | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402456524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7605209774 | ||||||||
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| Practice Location | |||||||||
| Address1: | 310 N L ROGERS WELLS BLVD | ||||||||
| Address2: | |||||||||
| City: | GLASGOW | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421411300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706595555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | R4756 | KY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 390200000X | MT214628 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 56739 | KY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.