Provider Demographics
NPI:1649258088
Name:SAHETYA, KALIDAS G (MD)
Entity type:Individual
Prefix:
First Name:KALIDAS
Middle Name:G
Last Name:SAHETYA
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:PO BOX 90039
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-9039
Mailing Address - Country:US
Mailing Address - Phone:270-796-8800
Mailing Address - Fax:270-796-9328
Practice Address - Street 1:427 US 31W BYP
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1703
Practice Address - Country:US
Practice Address - Phone:270-796-8800
Practice Address - Fax:270-796-9328
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20980207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000050059OtherANTHEM BCBS
KY64209802Medicaid
KY0660002Medicare ID - Type Unspecified
KY0663201Medicare ID - Type Unspecified
KY64209802Medicaid
KY000000050059OtherANTHEM BCBS
KY0663301Medicare ID - Type Unspecified