Provider Demographics
NPI:1316917131
Name:RASHIDIAN, JOHN B (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:B
Last Name:RASHIDIAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 N ELM STREET
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420
Mailing Address - Country:US
Mailing Address - Phone:270-826-0838
Mailing Address - Fax:270-830-0371
Practice Address - Street 1:1023 N ELM STREET
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420
Practice Address - Country:US
Practice Address - Phone:270-826-0838
Practice Address - Fax:270-830-0371
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033238A207V00000X
KY20634207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64206345Medicaid
KY20634OtherLICENSE
KY20634OtherLICENSE
KY64206345Medicaid