Provider Demographics
NPI:1013151968
Name:BARACALDO, RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:BARACALDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAFAEL
Other - Middle Name:MAURICIO
Other - Last Name:BARACALDO VILLALBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6400 DUTCHMANS PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3354
Mailing Address - Country:US
Mailing Address - Phone:502-587-9660
Mailing Address - Fax:502-540-5615
Practice Address - Street 1:6400 DUTCHMANS PKWY STE 250
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3354
Practice Address - Country:US
Practice Address - Phone:502-587-9660
Practice Address - Fax:502-540-5615
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-37029207RN0300X
KYTP737207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology