MEDICARE: SHAILESH Y BHOPATKAR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	37716	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000300822	OTHER	KY	ANTHEM

General Provider Information

NPI Number	:	1407806318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAILESH Y BHOPATKAR M.D.

Provider Business Mailing Address
First Line	:	100 E LIBERTY ST
Second Line	:	SUITE 800
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1434
Country	:	US
Telephone Number	:	502-315-1458
Fax Number	:	502-479-1425

Provider Business Practice Location Address
First Line	:	1001 SAINT JOSEPH LN
Second Line	:
City	:	LONDON
State	:	KY
Zip	:	40741-8345
Country	:	US
Telephone Number	:	606-330-6000
Fax Number	:	606-330-7825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	02/03/2015

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