Provider Demographics
NPI:1366544942
Name:BADENHAUSEN, WALTER E JR (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:E
Last Name:BADENHAUSEN
Suffix:JR
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 1:490 LIGHTFOOT RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1854
Mailing Address - Country:US
Mailing Address - Phone:502-587-1236
Mailing Address - Fax:502-587-0318
Practice Address - Street 1:490 LIGHTFOOT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-1854
Practice Address - Country:US
Practice Address - Phone:502-587-1236
Practice Address - Fax:502-587-0318
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY079020207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY097020OtherSTATE LICENSE
KY64138332Medicaid
KY64138332Medicaid
KY1269502Medicare ID - Type Unspecified