Provider Demographics
NPI:1952652307
Name:PRADHAN, GINIUS (MD)
Entity Type:Individual
Prefix:DR
First Name:GINIUS
Middle Name:
Last Name:PRADHAN
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 1:721 S PRESTON ST FL 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2319
Mailing Address - Country:US
Mailing Address - Phone:502-583-1799
Mailing Address - Fax:502-583-1792
Practice Address - Street 1:721 S PRESTON ST FL 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2319
Practice Address - Country:US
Practice Address - Phone:502-583-1799
Practice Address - Fax:502-583-1792
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01075207A207RN0300X
KY48314207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201287420Medicaid
KY7100358460Medicaid