Provider Demographics
NPI:1992777049
Name:KAKADE, GAUTAM (MD)
Entity type:Individual
Prefix:
First Name:GAUTAM
Middle Name:
Last Name:KAKADE
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 1:1316 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-2019
Mailing Address - Country:US
Mailing Address - Phone:515-532-2811
Mailing Address - Fax:
Practice Address - Street 1:1316 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525-2019
Practice Address - Country:US
Practice Address - Phone:515-532-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-36193207X00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0655001Medicaid
IA0600460Medicaid
IA33444OtherWMC FPC - BCBS
IA66046OtherWMC BCBS SNF
IA03187OtherBC/BS
IAP00264034OtherRR MEDICARE
IA0283465Medicaid
IA161302OtherWMC MEDICARE
IA163495OtherWMC FPC MEDICARE
IA16Z302OtherWMC MEDICARE SKILLED
IA0475806Medicaid
IA60046OtherWMC-BCBS
IA0293522Medicaid
IA0635011Medicaid
IA29352OtherWMC-BCBS ER
IA0424507Medicaid
IADA 1838OtherWMC FPC - MEDICARE RR
IA36174OtherWMC - BCBS DME
IA0635011Medicaid
IA0655001Medicaid