Provider Demographics
NPI:1225087612
Name:GAITONDE, RAJDEEP S (DO)
Entity Type:Individual
Prefix:
First Name:RAJDEEP
Middle Name:S
Last Name:GAITONDE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-585-4321
Mailing Address - Fax:502-566-6338
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:SUITE 305
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1882
Practice Address - Country:US
Practice Address - Phone:502-585-4321
Practice Address - Fax:502-566-6338
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03865207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ361019Medicaid
KY7100391280Medicaid
KYK161920Medicare PIN
AZZ131759Medicare PIN
INH92555Medicare UPIN
AZ124271Medicare PIN
KYP01537178Medicare PIN