Provider Demographics
NPI:1497711543
Name:QUIJANO, RENNAN M (MD)
Entity Type:Individual
Prefix:
First Name:RENNAN
Middle Name:M
Last Name:QUIJANO
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 1:550 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1652
Mailing Address - Country:US
Mailing Address - Phone:270-824-9898
Mailing Address - Fax:270-824-9185
Practice Address - Street 1:550 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1652
Practice Address - Country:US
Practice Address - Phone:270-824-9898
Practice Address - Fax:270-824-9185
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29115208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000108208OtherBLUE CROSS BLUE SHIELD
KY64291156Medicaid
000000108208OtherBLUE CROSS BLUE SHIELD
KYF30978Medicare UPIN