Provider Demographics
NPI:1831367424
Name:FRATTINI, JARED C (MD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:C
Last Name:FRATTINI
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 1:1532 LONE OAK RD STE 235
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7946
Mailing Address - Country:US
Mailing Address - Phone:270-442-9463
Mailing Address - Fax:
Practice Address - Street 1:1532 LONE OAK RD STE 235
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7946
Practice Address - Country:US
Practice Address - Phone:270-442-9463
Practice Address - Fax:270-442-2241
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP687208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000222200Medicaid
FL42566OtherBLUE CROSS BLUE SHIELD
FLAL513XMedicare PIN