Provider Demographics
NPI:1457355893
Name:RANKIN, BRADLEY T (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:T
Last Name:RANKIN
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 1:9800 SHELBYVILLE RD
Mailing Address - Street 2:SUITE #220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2992
Mailing Address - Country:US
Mailing Address - Phone:502-429-8585
Mailing Address - Fax:855-656-7325
Practice Address - Street 1:2312 KENTUCKY AVENUE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003
Practice Address - Country:US
Practice Address - Phone:270-442-5151
Practice Address - Fax:855-656-7325
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25721207K00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64257215Medicaid
KYP00824071OtherRAILROAD MEDICARE
KY112007OtherSHIO
KY65934465Medicaid
KYP00824071OtherRAILROAD MEDICARE
KY00000053369OtherANTHEM
KY65934465Medicaid
KYP00824071OtherRAILROAD MEDICARE
KY682425Medicare PIN