Provider Demographics
NPI:1972980738
Name:PARACKAL, PAUL T (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:T
Last Name:PARACKAL
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 1:401 E. CHESTNUT STREET
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-588-4865
Mailing Address - Fax:502-588-4427
Practice Address - Street 1:401 E. CHESTNUT STREET
Practice Address - Street 2:SUITE 600
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-588-4865
Practice Address - Fax:502-588-4427
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2016-08-24
Deactivation Date:2015-12-09
Deactivation Code:
Reactivation Date:2016-08-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program