Provider Demographics
NPI:1942319801
Name:PAGANI, LUIS (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:PAGANI
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 1:2123 AUBURN AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1758
Mailing Address - Country:US
Mailing Address - Phone:513-241-2123
Mailing Address - Fax:513-241-0417
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:STE 310
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1758
Practice Address - Country:US
Practice Address - Phone:513-241-2123
Practice Address - Fax:513-241-0417
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-1000172084N0400X
KY175012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0266313Medicaid
05-20140OtherUNITED HEALTHCARE
1825075-001OtherCIGNA
OC05275OtherNATIONWIDE HEALTH PLAN
311412447061OtherCARESOURCE
2074982OtherAETNA
KY64763865Medicaid
000000019790OtherANTHEM
IN100356920AMedicaid
A75825Medicare UPIN
KY0306031Medicare ID - Type Unspecified
KY64763865Medicaid
OH0266313Medicaid