Provider Demographics
NPI:1437577731
Name:JAKATDAR, AVANTI
Entity Type:Individual
Prefix:
First Name:AVANTI
Middle Name:
Last Name:JAKATDAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 DIXIE HWY STE D
Mailing Address - Street 2:
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2882
Mailing Address - Country:US
Mailing Address - Phone:859-341-5757
Mailing Address - Fax:859-331-4757
Practice Address - Street 1:1955 DIXIE HWY STE D
Practice Address - Street 2:
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41011-2882
Practice Address - Country:US
Practice Address - Phone:859-341-5757
Practice Address - Fax:859-331-4757
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50824207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine