Basic Information
| Provider Information | |||||||||
| NPI: | 1831355510 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JYOTULA | ||||||||
| FirstName: | KAVITA | ||||||||
| MiddleName: | SRIDEVI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 E LIBERTY ST STE 800 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023673360 | ||||||||
| FaxNumber: | 5023673365 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 BLUEGRASS AVE | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402151161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023673360 | ||||||||
| FaxNumber: | 5023673365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2008 | ||||||||
| LastUpdateDate: | 03/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 57.012678 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | TP390 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 43840 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 201009210 | 05 | IN | MEDICAID | P00894830 | 01 | KY | MEDICARE RR | OTHER | 7100102180 | 05 | KY | MEDICAID |