Provider Demographics
NPI:1407806318
Name:BHOPATKAR, SHAILESH Y (MD)
Entity Type:Individual
Prefix:
First Name:SHAILESH
Middle Name:Y
Last Name:BHOPATKAR
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 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-315-1458
Mailing Address - Fax:502-479-1425
Practice Address - Street 1:1001 SAINT JOSEPH LN
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8345
Practice Address - Country:US
Practice Address - Phone:606-330-6000
Practice Address - Fax:606-330-7825
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37716207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64095219Medicaid
KY000000300822OtherANTHEM
KYP00042384Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KY64095219Medicaid
KYK109060Medicare PIN
KY000000300822OtherANTHEM
KY0750826Medicare ID - Type UnspecifiedMEDICARE