Provider Demographics
NPI:1134184567
Name:GAEKWAD, SATYAJEET Y (MD)
Entity type:Individual
Prefix:DR
First Name:SATYAJEET
Middle Name:Y
Last Name:GAEKWAD
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 1:705 ELM ST SW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1956
Mailing Address - Country:US
Mailing Address - Phone:541-812-4580
Mailing Address - Fax:541-928-3169
Practice Address - Street 1:705 ELM ST SW
Practice Address - Street 2:SUITE 300
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1956
Practice Address - Country:US
Practice Address - Phone:541-812-4580
Practice Address - Fax:541-928-3169
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS426885208600000X
ORMD26995208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100288230AMedicaid
KS100288230AMedicaid
KSG66702Medicare UPIN