Kedlaya, Divakara

Kedlaya, Divakara is an individual health care provider with primary practice located at 1925 E Orman Ave Suite A235, Pueblo CO 81004-3537. He recently has only one registered license in Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, which is considered as his primary health care specialty. Kedlaya, Divakara can be contacted via phone (719) 557-3666.

Contact Information

Primary practice address
1925 E Orman Ave Suite A235 Pueblo CO 81004-3537
Phone: (719) 557-3666
Fax: (719) 557-3633
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X A055622 California
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 036147433 Illinois
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 44383 Colorado

Profile Details

NPI number 1134104037
LBN Legal business name Kedlaya, Divakara
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 13th, 2005
Last updated Feb 6th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134104037 NPPES
Colorado MEDICAID 42809223

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