Provider Demographics
NPI:1487634176
Name:JADAV, PRAGNA R (MD)
Entity Type:Individual
Prefix:
First Name:PRAGNA
Middle Name:R
Last Name:JADAV
Suffix:
Gender:F
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:289 IRELAND AVE
Practice Address - Street 2:IRELAND ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-5111
Practice Address - Country:US
Practice Address - Phone:502-624-9396
Practice Address - Fax:502-624-0241
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00319190OtherRRMCR - NICC
P00243353OtherRRMCR - NICC
000000381975OtherANTHEM - NICC
064434OtherSIHO - NICC
KYP00319190OtherRRMCR - NICC
000000381975OtherANTHEM - NICC