Provider Demographics
NPI:1992741706
Name:PANCHAL, VIPUL R (MD)
Entity type:Individual
Prefix:
First Name:VIPUL
Middle Name:R
Last Name:PANCHAL
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:6420 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-891-8300
Practice Address - Fax:502-891-8338
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37828207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000293982OtherANTHEM PIN
KY2209313000OtherPASSPORT ADVANTAGE PIN
KY50031168OtherPASSPORT- CTS
KY64064785Medicaid
IN200423290AMedicaid
KY000057080OOtherHUMANA- CARDIOTHORACIC SURGERY OF LOUISVILLE
IN200423290FMedicaid
KYP00893031OtherRAILROAD MEDICARE- CTS
KY000000693044OtherANTHEM- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY50000940OtherPASSPORT PIN
KY1271847Medicare ID - Type Unspecified
IN200423290AMedicaid
IN200423290FMedicaid
KY060071390Medicare PIN
KY0558519Medicare ID - Type Unspecified
KYH80944Medicare UPIN
KY0368215Medicare ID - Type Unspecified
KY000000693044OtherANTHEM- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY50000940OtherPASSPORT PIN
KY0558418Medicare ID - Type Unspecified
KY0558215Medicare ID - Type Unspecified
KYP400031794Medicare PIN