MEDICARE: DR. INDRA RASTOGI 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	208000000X	Pediatrics Physician	19877	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

General Provider Information

NPI Number	:	1689607095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INDRA RASTOGI M.D.

Provider Business Mailing Address
First Line	:	7807 SHELBYVILLE RD
Second Line	:	STE 100
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-5495
Country	:	US
Telephone Number	:	606-878-8100
Fax Number	:	606-864-7878

Provider Business Practice Location Address
First Line	:	202 W 7TH ST
Second Line	:	SUITE 200
City	:	LONDON
State	:	KY
Zip	:	40741-1763
Country	:	US
Telephone Number	:	606-878-8100
Fax Number	:	606-864-7878

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	12/11/2017

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