Provider Demographics
NPI:1285813469
Name:CHIAKI GAUNTT MD PLLC
Entity type:Organization
Organization Name:CHIAKI GAUNTT MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:APPLEGATE
Authorized Official - Suffix:
Authorized Official - Credentials:COT
Authorized Official - Phone:502-645-8539
Mailing Address - Street 1:6307 MINT SPRING BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8614
Mailing Address - Country:US
Mailing Address - Phone:502-645-8539
Mailing Address - Fax:812-944-5496
Practice Address - Street 1:1917 S HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-8574
Practice Address - Country:US
Practice Address - Phone:502-645-8539
Practice Address - Fax:812-944-5496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39795261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty