Basic Information
| Provider Information | |||||||||
| NPI: | 1902821739 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VINAYAKAN | ||||||||
| FirstName: | ANILKUMAR | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 E BROADWAY STE 185-E | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026295455 | ||||||||
| FaxNumber: | 5026294151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 01/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 38717 | KY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 38717 | KY | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00533130 | 01 | KY | MEDICARE - KY - NNS | OTHER | 50023844 | 01 | KY | PASSPORT - NNS | OTHER | P00726826 | 01 | KY | RR MCR KY - NNS | OTHER | 104597 | 01 | KY | SIHO - NNS | OTHER | 000000615042 | 01 | KY | ANTHEM - NNS | OTHER | 000023036L | 01 | KY | HUMANA - NNS | OTHER | 200493420 | 05 | IN | MEDICAID | 64085335 | 01 | KY | MEDICAID-KY - NNS | OTHER |