Basic Information
| Provider Information | |||||||||
| NPI: | 1164463931 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIFALDI | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 189 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472500189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128010840 | ||||||||
| FaxNumber: | 8128010024 | ||||||||
| Practice Location | |||||||||
| Address1: | 1373 E STATE ROAD 62 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472507328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128010840 | ||||||||
| FaxNumber: | 8128010024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 04/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 01048639 | IN | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 020041434 | 01 | MEDICARE RAILROAD | OTHER | 268222 | 01 | BLACK LUNG | OTHER | 64881477 | 05 | KY | MEDICAID | 000000042191 | 01 | ANTHEM BCBS | OTHER | 1087692 | 01 | KY | KENTUCKY PASSPORT MEDICAI | OTHER | 810895P | 01 | SIHO | OTHER | 5745357 | 01 | AETNA | OTHER | 2435771000 | 01 | KY | PASSPORT ADVANTAGE | OTHER | 200180740A | 05 | IN | MEDICAID |