Provider Demographics
NPI:1790784320
Name:CAGATA, ARDEL C (MD)
Entity Type:Individual
Prefix:
First Name:ARDEL
Middle Name:C
Last Name:CAGATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ARDYLE
Other - Middle Name:
Other - Last Name:CAGATA
Other - Suffix:
Other - Last Name Type:Other Name
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 1:200 E CHESTNUT ST
Practice Address - Street 2:SERVICES BLDG, STE 303
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-6552
Practice Address - Fax:502-629-3132
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30478207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64304785Medicaid
IN200270800Medicaid
KY3682676OtherCIGNA - NICS
KY3730062000OtherPASSPORT ADVANTAGE - NICS
KY000000625001OtherANTHEM - NICS
KY055105OtherSIHO - NICS
KY611276316UOtherHUMANA - NICS
KY50025123OtherPASSPORT - NICS
IN200270800Medicaid
KYP00773833Medicare PIN
KY000000625001OtherANTHEM - NICS
KY64304785Medicaid