| Doctor Name: | DR. INDIRA MOODUMANE |
| NPI Number: | 1639181340 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 36054 |
| Business Practice Address: | 809 Meyers Baker Rd Suite 1 London, KY - 407413025 |
| Business Phone Number: | 6068647337 |
| Business Fax Number: | 6068783257 |
| Mailing Address: | Po Box 689, LONDON |
| State: | KY |
| Postal Code: | 407430689 |
| Phone Number: | 6068647337 |
| Fax Number: | 6068783257 |
| NPI Enumeration Date: | 08/12/2006 |
| NPI Last Update Date: | 06/24/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 36054 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |