Provider Demographics
NPI:1760554067
Name:KALOKHE, PRADEEP VAMANRAO (MD)
Entity Type:Individual
Prefix:
First Name:PRADEEP
Middle Name:VAMANRAO
Last Name:KALOKHE
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:PO BOX 9208
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-9208
Mailing Address - Country:US
Mailing Address - Phone:219-838-1718
Mailing Address - Fax:219-838-4883
Practice Address - Street 1:8427 KENNEDY AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-1140
Practice Address - Country:US
Practice Address - Phone:219-838-1718
Practice Address - Fax:219-838-4883
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031327A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100212640AMedicaid
INC25461Medicare UPIN
IN100212640AMedicaid