Provider Demographics
NPI:1336165943
Name:AMIN, RAJANBHAI R (MD)
Entity Type:Individual
Prefix:
First Name:RAJANBHAI
Middle Name:R
Last Name:AMIN
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 1:1505 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-1710
Mailing Address - Country:US
Mailing Address - Phone:502-637-1005
Mailing Address - Fax:502-635-0046
Practice Address - Street 1:1505 S 7TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1710
Practice Address - Country:US
Practice Address - Phone:502-637-1005
Practice Address - Fax:502-635-0046
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1049786OtherPASSPORT HEALTH PLAN
KY65911745Medicaid
KY000000049503OtherANTHEM BC&BS
KY2432664000OtherPASSPORT ADVANTAGE
KY1049781OtherPASSPORT HEALTH PLAN
KY2432665000OtherPASSPORT ADVANTAGE
KY64193402Medicaid
KY1049789OtherPASSPORT HEALTH PLAN
KY2432662000OtherPASSPORT ADVANTAGE
KY611182904EOtherHUMANA
KY2432664000OtherPASSPORT ADVANTAGE
KY2432665000OtherPASSPORT ADVANTAGE
KY64193402Medicaid
KY611182904EOtherHUMANA
KY1049781OtherPASSPORT HEALTH PLAN