Basic Information
| Provider Information | |||||||||
| NPI: | 1558095299 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAGA | ||||||||
| FirstName: | PAWAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 941 BAXTER AVE UNIT 106 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402042093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5027759097 | ||||||||
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| Practice Location | |||||||||
| Address1: | 550 SOUTH JACKSON STREET | ||||||||
| Address2: | INTERNAL MED RESIDENCY PROGRAM, ACB 3RD FLOOR | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402024020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028525666 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2022 | ||||||||
| LastUpdateDate: | 07/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.