Provider Demographics
NPI:1679732051
Name:RAHEJA, PRAFULL (MD)
Entity type:Individual
Prefix:
First Name:PRAFULL
Middle Name:
Last Name:RAHEJA
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 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800 - BUSINESS OFFICE
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-581-1951
Mailing Address - Fax:502-540-5137
Practice Address - Street 1:201 ABRAHAM FLEXNER WAY
Practice Address - Street 2:SUITE 1101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3841
Practice Address - Country:US
Practice Address - Phone:502-581-1951
Practice Address - Fax:502-540-5137
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44271207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100425760 (KOHMG)Medicaid
IN201363930A (KOHMG)Medicaid
KYK202930 (KOHMG)Medicare PIN
IN201363930A (KOHMG)Medicaid