Healthcare Provider Details

I. General information

NPI: 1225087612
Provider Name (Legal Business Name): RAJDEEP S. GAITONDE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ABRAHAM FLEXNER WAY SUITE 305
LOUISVILLE KY
40202-1882
US

IV. Provider business mailing address

100 E LIBERTY ST SUITE 800
LOUISVILLE KY
40202-1434
US

V. Phone/Fax

Practice location:
  • Phone: 502-585-4321
  • Fax: 502-566-6338
Mailing address:
  • Phone: 502-585-4321
  • Fax: 502-566-6338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number03865
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: