Provider Demographics
NPI:1174669600
Name:GATAKY, GEORGE J (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:GATAKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3 AUDUBON PLAZA DR
Mailing Address - Street 2:SUITE 630
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1300
Mailing Address - Country:US
Mailing Address - Phone:502-326-8588
Mailing Address - Fax:502-326-8589
Practice Address - Street 1:3 AUDUBON PLAZA DR
Practice Address - Street 2:SUITE 630
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1300
Practice Address - Country:US
Practice Address - Phone:502-326-8588
Practice Address - Fax:502-326-8589
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY14083207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC66679Medicare UPIN
KY0921044Medicare ID - Type Unspecified
KYK198260Medicare PIN