Provider Demographics
NPI:1194734152
Name:SHETH, RAJESH K (MD)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:K
Last Name:SHETH
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 1:332 W BROADWAY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2116
Mailing Address - Country:US
Mailing Address - Phone:502-583-2759
Mailing Address - Fax:502-583-2760
Practice Address - Street 1:332 W BROADWAY
Practice Address - Street 2:SUITE 600
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2116
Practice Address - Country:US
Practice Address - Phone:502-583-2759
Practice Address - Fax:502-583-2760
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64227697Medicaid
1463601Medicare ID - Type Unspecified
C66982Medicare UPIN