Provider Demographics
NPI:1083636930
Name:AZAD, DEEPAK G (MD)
Entity type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:G
Last Name:AZAD
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 1:3505 CHARLEVOIX CT
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9761
Mailing Address - Country:US
Mailing Address - Phone:502-216-2900
Mailing Address - Fax:
Practice Address - Street 1:3505 CHARLEVOIX CT
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9761
Practice Address - Country:US
Practice Address - Phone:502-216-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043333207RA0000X
KY35511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64880099Medicaid
IN200028800BMedicaid
KYK159140Medicare PIN
G01626Medicare UPIN
IN178270Medicare PIN