Provider Demographics
NPI:1174700520
Name:RAMESH S GAUD MD PC
Entity type:Organization
Organization Name:RAMESH S GAUD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:S
Authorized Official - Last Name:GAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-866-5614
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-0010
Mailing Address - Country:US
Mailing Address - Phone:219-866-5614
Mailing Address - Fax:219-866-5731
Practice Address - Street 1:770 W WINDING RD
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-7284
Practice Address - Country:US
Practice Address - Phone:219-866-5614
Practice Address - Fax:219-866-5731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028099A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100312650Medicaid
IN390730Medicare PIN