Provider Demographics
NPI:1164463931
Name:GIFALDI, AMY SUE (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
Last Name:GIFALDI
Suffix:
Gender:F
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:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-0189
Mailing Address - Country:US
Mailing Address - Phone:812-801-0840
Mailing Address - Fax:812-801-0024
Practice Address - Street 1:1373 E STATE ROAD 62
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-7328
Practice Address - Country:US
Practice Address - Phone:812-801-0840
Practice Address - Fax:812-801-0024
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048639208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
020041434OtherMEDICARE RAILROAD
268222OtherBLACK LUNG
KY64881477Medicaid
000000042191OtherANTHEM BCBS
KY1087692OtherKENTUCKY PASSPORT MEDICAI
810895POtherSIHO
5745357OtherAETNA
KY2435771000OtherPASSPORT ADVANTAGE
IN200180740AMedicaid
IN412580SMedicare ID - Type Unspecified
IN200180740AMedicaid
KY2435771000OtherPASSPORT ADVANTAGE
IN020041434Medicare PIN