Provider Demographics
NPI:1891729695
Name:SALDANA-GAUTIER, LUIS R (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:R
Last Name:SALDANA-GAUTIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:R
Other - Last Name:SALDANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4899 CHESTNUT HILL DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-3805
Mailing Address - Country:US
Mailing Address - Phone:513-673-7504
Mailing Address - Fax:
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:SUITE 4300
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1264
Practice Address - Country:US
Practice Address - Phone:937-610-3220
Practice Address - Fax:937-610-3225
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-028739207VM0101X, 207V00000X, 207VC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VC0200XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0543684Medicaid
KY6489571Medicaid
OHSA0577609Medicare PIN
C03022Medicare UPIN
OHSA4266751Medicare PIN