Provider Demographics
NPI:1578788386
Name:YAMRAJ, GANESH (MD)
Entity Type:Individual
Prefix:
First Name:GANESH
Middle Name:
Last Name:YAMRAJ
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 1:279 KINGS DAUGHTERS DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-6514
Mailing Address - Country:US
Mailing Address - Phone:270-871-8264
Mailing Address - Fax:
Practice Address - Street 1:279 KINGS DAUGHTERS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-6514
Practice Address - Country:US
Practice Address - Phone:270-871-8264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY41118OtherKENTUCKY STATE LICENSE