Provider Demographics
NPI:1346309465
Name:RAFLA, EMMANUEL K (MD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:K
Last Name:RAFLA
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 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-584-0166
Mailing Address - Fax:502-584-0144
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1818
Practice Address - Country:US
Practice Address - Phone:502-584-0166
Practice Address - Fax:502-584-0144
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35618207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000076793OtherANTHEM
KY1114109Medicaid
KY64009897Medicaid
KY000000076793Medicare ID - Type UnspecifiedANTHEM SENIOR ADVANTAGE
E54647Medicare UPIN
KY2436835000Medicare ID - Type UnspecifiedPASSPORT ADVANTAGE
KY0399842Medicare ID - Type Unspecified