Provider Demographics
NPI:1003993098
Name:NATARAJ, HIRESADARAHALLI C (MD)
Entity Type:Individual
Prefix:
First Name:HIRESADARAHALLI
Middle Name:C
Last Name:NATARAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 SHELBYVILLE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2992
Mailing Address - Country:US
Mailing Address - Phone:502-429-8585
Mailing Address - Fax:855-656-7325
Practice Address - Street 1:7287 SAWMILL RD STE 100
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9609
Practice Address - Country:US
Practice Address - Phone:614-760-0099
Practice Address - Fax:855-656-7325
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.068336207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0153060Medicaid
OH030005113OtherRAILROAD MEDICARE
OH0781919Medicare PIN
OH0781918Medicare PIN
OH4019672Medicare PIN
OH0153060Medicaid
OH9309361Medicare PIN
OH9309363Medicare PIN
G03463Medicare UPIN
OH9309362Medicare PIN