Provider Demographics
NPI:1750394516
Name:PANDIT, KULDEEP RAJ (MD)
Entity type:Individual
Prefix:DR
First Name:KULDEEP
Middle Name:RAJ
Last Name:PANDIT
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 1:327 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2929
Mailing Address - Country:US
Mailing Address - Phone:270-826-1234
Mailing Address - Fax:270-826-4841
Practice Address - Street 1:327 N ELM ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2929
Practice Address - Country:US
Practice Address - Phone:270-826-1234
Practice Address - Fax:270-826-4841
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27834207RP1001X
IN01039387A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64278344Medicaid
KY000000049673OtherIN AND KY BCBS #
IN200124930AMedicaid
KYK008692OtherTRICARE CHAMPUS #
KYK008692OtherTRICARE CHAMPUS #
KYC35103Medicare UPIN
KY1520201Medicare ID - Type UnspecifiedKY MEDICARE #
KY611199965OtherTAX ID NUMBER