Healthcare Provider Details

I. General information

NPI: 1891811840
Provider Name (Legal Business Name): PLACERVILLE INTERNAL MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FOWLER WAY SUITE 6
PLACERVILLE CA
95667-5738
US

IV. Provider business mailing address

PO BOX 587
PLACERVILLE CA
95667-0587
US

V. Phone/Fax

Practice location:
  • Phone: 530-622-9400
  • Fax: 530-622-9440
Mailing address:
  • Phone: 530-622-9400
  • Fax: 530-622-9440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KETAN P AJUDIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 530-622-9400