Provider Demographics
NPI:1689607095
Name:RASTOGI, INDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:INDRA
Middle Name:
Last Name:RASTOGI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7807 SHELBYVILLE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5495
Mailing Address - Country:US
Mailing Address - Phone:606-878-8100
Mailing Address - Fax:606-864-7878
Practice Address - Street 1:202 W 7TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1763
Practice Address - Country:US
Practice Address - Phone:606-878-8100
Practice Address - Fax:606-864-7878
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY19877208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64198773Medicaid
KY64198773Medicaid
KY0040402Medicare ID - Type Unspecified