Provider Demographics
NPI:1154521979
Name:PAIS, ROSHAN (MD)
Entity type:Individual
Prefix:DR
First Name:ROSHAN
Middle Name:
Last Name:PAIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:STE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:859-986-2344
Mailing Address - Fax:859-986-6768
Practice Address - Street 1:305 ESTILL ST
Practice Address - Street 2:HOSPITALIST DEPT
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1742
Practice Address - Country:US
Practice Address - Phone:859-986-2344
Practice Address - Fax:859-986-6768
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH090370207R00000X
KY41187207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100021370Medicaid
KYP00466697OtherMEDICARE RAILROAD
KY7100021370Medicaid